Provider Demographics
NPI:1912346404
Name:BRASWELL, BRINDA J
Entity Type:Individual
Prefix:MISS
First Name:BRINDA
Middle Name:J
Last Name:BRASWELL
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 1:2971 ELDRON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6498
Mailing Address - Country:US
Mailing Address - Phone:321-914-8284
Mailing Address - Fax:321-728-9351
Practice Address - Street 1:2971 ELDRON BLVD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6498
Practice Address - Country:US
Practice Address - Phone:321-914-8284
Practice Address - Fax:321-728-9351
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11827310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility