Provider Demographics
NPI:1770584807
Name:BREWINGTON, JANISE A (FNP)
Entity type:Individual
Prefix:
First Name:JANISE
Middle Name:A
Last Name:BREWINGTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 ALT 19 STE B
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1424
Mailing Address - Country:US
Mailing Address - Phone:727-787-4875
Mailing Address - Fax:727-786-9623
Practice Address - Street 1:4705 ALT 19 STE B
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1424
Practice Address - Country:US
Practice Address - Phone:727-787-4875
Practice Address - Fax:727-786-9623
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC031848-RN163W00000X, 363LF0000X
NC200856363L00000X
FLAPRN1451072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005525Medicaid
NC7005525Medicaid
NC2599204BMedicare PIN
NC2599204AMedicare PIN
NCB223CMedicare PIN