Basic Information
Provider Information
NPI: 1457454829
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BREWER
FirstName: ERIN
MiddleName: MARCIA
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 14843
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326044843
CountryCode: US
TelephoneNumber: 3523751116
FaxNumber:  
Practice Location
Address1: BRANCH MEDICAL DENTAL CLINIC, BLDG 964
Address2: NAVAL AIR STATION
City: JACKSONVILLE
State: FL
PostalCode: 32212
CountryCode: US
TelephoneNumber: 9045423500
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/07/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X533632FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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