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NPI Code Detail

MEDICARE: AWAKEN BRAIN HEALTH

MEDICARE: AWAKEN BRAIN HEALTH
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1679420665
Entity Type Code : Organization
Provider Name (Legal Business Name) : AWAKEN BRAIN HEALTH
Provider Business Mailing Address
First Line : 210 CRYSTAL CT
Second Line :
City : NICEVILLE
State : FL
Zip : 32578-4715
Country : US
Telephone Number : 850-307-7045
Fax Number :
Provider Business Practice Location Address
First Line : 3101 W MICHIGAN AVE STE D
Second Line :
City : PENSACOLA
State : FL
Zip : 32526-1876
Country : US
Telephone Number : 850-307-7045
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KRISTEN BRINKMAN
Credential :
Telephone Number : 850-307-7045
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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