Provider Demographics
NPI:1265093074
Name:FREY, NEIL JOHNATHON (APRN)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:JOHNATHON
Last Name:FREY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 ALLISON DR
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-6405
Mailing Address - Country:US
Mailing Address - Phone:321-282-1499
Mailing Address - Fax:321-256-6212
Practice Address - Street 1:341 ALLISON DR
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-6405
Practice Address - Country:US
Practice Address - Phone:321-543-9830
Practice Address - Fax:321-256-6212
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002739363LA2100X, 363LG0600X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health