Provider Demographics
NPI:1912455981
Name:BRAINARD, MEREDITH (ARNP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:BRAINARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:ALVAREZ, SHIPPEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 PARADISE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-6123
Mailing Address - Country:US
Mailing Address - Phone:423-715-8037
Mailing Address - Fax:
Practice Address - Street 1:841 PRUDENTIAL DR
Practice Address - Street 2:10TH FLOOR
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-398-5404
Practice Address - Fax:904-391-5545
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9315711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01739192OtherRR MEDICARE
FLIS762ZMedicare PIN