Provider Demographics
NPI:1912527961
Name:KREMER, BRIEANNE NICHOLE
Entity Type:Individual
Prefix:
First Name:BRIEANNE
Middle Name:NICHOLE
Last Name:KREMER
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 1:31 DOUBLE EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-6244
Mailing Address - Country:US
Mailing Address - Phone:850-292-3138
Mailing Address - Fax:
Practice Address - Street 1:220 EGLIN PKWY NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2857
Practice Address - Country:US
Practice Address - Phone:850-292-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015490363LA2200X
FL9433862163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse