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General NPI Number Information
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NPI Number | 1619742657
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Entity Type | Organization
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Legal Business Name | BRAVERY NE FL LLC
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 1 NEWS PL STE A130
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-6509
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Country | US
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Telephone | 904-574-6405
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Fax | 904-513-1082
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Provider Business Mailing Address
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Address Line | 1 NEWS PL STE A130
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-6509
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Country | US
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Telephone | 904-574-6405
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Fax | 904-513-1082
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KEITH CARREGAL
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Credential |
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Telephone | 904-574-6405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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