Provider Demographics
NPI:1013005008
Name:BREVARD FIRST ASSISTANTS, INC.
Entity Type:Organization
Organization Name:BREVARD FIRST ASSISTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:STROBEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, RNFA, CNOR, ONC
Authorized Official - Phone:321-637-0553
Mailing Address - Street 1:5190 CINNAMON FERN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOHN
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3403
Mailing Address - Country:US
Mailing Address - Phone:321-637-0553
Mailing Address - Fax:321-637-0552
Practice Address - Street 1:5190 CINNAMON FERN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-3403
Practice Address - Country:US
Practice Address - Phone:321-637-0553
Practice Address - Fax:321-637-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2961272364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperativeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2961272OtherFLORIDA NURSING LICENSE