1508900564 NPI number — COMMUNITY BASED CARE OF BREVARD

Table of content: BRITTANY ELAINE TOLAR NP (NPI 1902501133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508900564 NPI number — COMMUNITY BASED CARE OF BREVARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY BASED CARE OF BREVARD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508900564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 NORTH DR STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32934-9247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-752-4650
Provider Business Mailing Address Fax Number:
321-752-3188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 NORTH DR STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32934-9247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-752-4650
Provider Business Practice Location Address Fax Number:
321-752-3188
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NELLIUS
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
321-752-3183

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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