Provider Demographics
NPI:1114108404
Name:BRAY, EILEEN MUELLER (ARNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MUELLER
Last Name:BRAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-0648
Mailing Address - Country:US
Mailing Address - Phone:850-638-6240
Mailing Address - Fax:
Practice Address - Street 1:1338 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1846
Practice Address - Country:US
Practice Address - Phone:850-638-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9261719363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology