MEDICARE: NEIL JOHNATHON FREY APRN

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	363LA2100X	Acute Care Nurse Practitioner	APRN11002739	FL
2	363LG0600X	Gerontology Nurse Practitioner	APRN11002739	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265093074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL JOHNATHON FREY APRN

Provider Business Mailing Address
First Line	:	341 ALLISON DR
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-6405
Country	:	US
Telephone Number	:	321-282-1499
Fax Number	:	321-256-6212

Provider Business Practice Location Address
First Line	:	341 ALLISON DR
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-6405
Country	:	US
Telephone Number	:	321-543-9830
Fax Number	:	321-256-6212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2019
Last Update Date	:	01/30/2021

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