MEDICARE: KAYLA JEANINE BREWER

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11020301	FL

General Provider Information

NPI Number	:	1639800626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA JEANINE BREWER

Provider Business Mailing Address
First Line	:	7210 OVERLAND PARK BLVD E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-4258
Country	:	US
Telephone Number	:	904-803-9197
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 CARMICHAEL AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2325
Country	:	US
Telephone Number	:	904-899-6300
Fax Number	:

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

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/21/2022

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