Provider Demographics
NPI:1215482054
Name:NIEVES, BRANDI R
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:R
Last Name:NIEVES
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:PO BOX 54723
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-4723
Mailing Address - Country:US
Mailing Address - Phone:904-239-3677
Mailing Address - Fax:904-866-4029
Practice Address - Street 1:6950 PHILIPS HWY
Practice Address - Street 2:SUITE 11
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6074
Practice Address - Country:US
Practice Address - Phone:904-239-3677
Practice Address - Fax:904-866-4029
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health