MEDICARE: JANISE A BREWINGTON FNP

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	163W00000X	Registered Nurse	031848-RN	NC
2	363L00000X	Nurse Practitioner	200856	NC
3	363LF0000X	Family Nurse Practitioner	031848-RN	NC
4	363LF0000X	Family Nurse Practitioner	APRN1451072	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770584807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANISE A BREWINGTON FNP

Provider Business Mailing Address
First Line	:	4705 ALT 19 STE B
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1424
Country	:	US
Telephone Number	:	727-787-4875
Fax Number	:	727-786-9623

Provider Business Practice Location Address
First Line	:	4705 ALT 19 STE B
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1424
Country	:	US
Telephone Number	:	727-787-4875
Fax Number	:	727-786-9623

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	10/01/2019

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