Provider Demographics
NPI:1437923240
Name:BREVIL, JENNY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:BREVIL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5678 GREEN ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7393
Mailing Address - Country:US
Mailing Address - Phone:954-663-2092
Mailing Address - Fax:
Practice Address - Street 1:5678 GREEN ISLAND DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-7393
Practice Address - Country:US
Practice Address - Phone:954-663-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029356363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care