MEDICARE: MRS. LISA ANN BREWER RN

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	163WC1600X	Continuing Education/Staff Development Registered Nurse	RN9542915	FL

General Provider Information

NPI Number	:	1992668735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA ANN BREWER RN

Provider Business Mailing Address
First Line	:	62 LEAVER DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-9749
Country	:	US
Telephone Number	:	304-590-0033
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 LEAVER DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-9749
Country	:	US
Telephone Number	:	304-590-0033
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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