MEDICARE: BREVARD FIRST ASSISTANTS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP2800X	Perioperative Clinical Nurse Specialist	2961272	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2961272	OTHER	FL	FLORIDA NURSING LICENSE

General Provider Information

NPI Number	:	1013005008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREVARD FIRST ASSISTANTS, INC.

Provider Business Mailing Address
First Line	:	5190 CINNAMON FERN BLVD
Second Line	:
City	:	PORT ST JOHN
State	:	FL
Zip	:	32927-3403
Country	:	US
Telephone Number	:	321-637-0553
Fax Number	:	321-637-0552

Provider Business Practice Location Address
First Line	:	5190 CINNAMON FERN BLVD
Second Line	:
City	:	PORT ST JOHN
State	:	FL
Zip	:	32927-3403
Country	:	US
Telephone Number	:	321-637-0553
Fax Number	:	321-637-0552

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. KELLI STROBEL
Credential	:	RN, RNFA, CNOR, ONC
Telephone Number	:	321-637-0553

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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