Provider Demographics
NPI:1346075942
Name:CHILDREN'S HEALTHCARE OF BREVARD
Entity type:Organization
Organization Name:CHILDREN'S HEALTHCARE OF BREVARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE-PRACTITIONER OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:WITZLEB
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:321-775-0477
Mailing Address - Street 1:2351 W EAU GALLIE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3114
Mailing Address - Country:US
Mailing Address - Phone:321-775-0477
Mailing Address - Fax:321-775-0476
Practice Address - Street 1:2351 W EAU GALLIE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3114
Practice Address - Country:US
Practice Address - Phone:321-775-0477
Practice Address - Fax:321-775-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty