Provider Demographics
NPI:1003184508
Name:INTERNAL MEDICINE OF BREVARD, PLLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF BREVARD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NOLAN
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:321-631-0392
Mailing Address - Street 1:1978 ROCKLEDGE BLVD
Mailing Address - Street 2:STE 108
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3722
Mailing Address - Country:US
Mailing Address - Phone:321-631-0392
Mailing Address - Fax:321-631-5787
Practice Address - Street 1:1978 ROCKLEDGE BLVD
Practice Address - Street 2:STE 108
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3722
Practice Address - Country:US
Practice Address - Phone:321-631-0392
Practice Address - Fax:321-631-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty