Basic Information
| Provider Information | |||||||||
| NPI: | 1902218506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAWNER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 9TH ST N STE 110 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396248490 | ||||||||
| FaxNumber: | 2396248491 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 9TH ST N STE 110 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396248490 | ||||||||
| FaxNumber: | 2396248491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2014 | ||||||||
| LastUpdateDate: | 12/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101261469 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QH0002X | 0101261469 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207RH0002X | 0101261469 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207QH0002X | ME137950 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | KI266 | 01 | FL | MEDICARE | OTHER | JH8X7 | 01 | FL | BCBS | OTHER | 101044500 | 05 | FL | MEDICAID |