Provider Demographics
NPI:1790663326
Name:BRAZELL, ANNETTE W
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:W
Last Name:BRAZELL
Suffix:
Gender:F
Credentials:
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 65952
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-0016
Mailing Address - Country:US
Mailing Address - Phone:904-584-5777
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 65952
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-0016
Practice Address - Country:US
Practice Address - Phone:904-584-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging