Provider Demographics
NPI:1629625116
Name:BRAZIL, JOANN LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:LYNN
Last Name:BRAZIL
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 1:109 S GREEN STREET
Mailing Address - Street 2:DR. TRICIA ETHERIDGE
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936
Mailing Address - Country:US
Mailing Address - Phone:184-372-6677
Mailing Address - Fax:843-726-6778
Practice Address - Street 1:TRICIA ETHERIDGE ST JOSEPH CANDLER
Practice Address - Street 2:109 GREEN STREET
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936
Practice Address - Country:US
Practice Address - Phone:843-726-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26238363LA2200X
NYF309202-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health