Provider Demographics
NPI:1568204089
Name:BOSTON, BRETT CHRISTOPHER (RN)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:CHRISTOPHER
Last Name:BOSTON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 WOLFE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8350
Mailing Address - Country:US
Mailing Address - Phone:828-448-9299
Mailing Address - Fax:
Practice Address - Street 1:1231 WOLFE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-8350
Practice Address - Country:US
Practice Address - Phone:828-448-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9574869163WC0200X
NC152014367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine