Provider Demographics
NPI:1841009461
Name:BREVARD TNT HOLDINGS
Entity type:Organization
Organization Name:BREVARD TNT HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSTEIN-SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:321-364-2822
Mailing Address - Street 1:7960 N WICKHAM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8096
Mailing Address - Country:US
Mailing Address - Phone:321-364-2822
Mailing Address - Fax:
Practice Address - Street 1:7960 N WICKHAM RD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8096
Practice Address - Country:US
Practice Address - Phone:321-364-2822
Practice Address - Fax:877-684-0805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIDENT HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty