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Organization
BREVARD HEALTH ALLIANCE
Active
Organization
BREVARD HEALTH ALLIANCE
Active
Other names
Heritage Park
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA CRAIG (DIRECTOR OF BILLING)
(321) 698-3446
Entity
Organization
Contact information
Practice address
2550 GRANT ST STE 137, MELBOURNE, FL 32901-6006
(321) 334-6940
(321) 334-6912
Mailing address
PO BOX 1137, MELBOURNE, FL 32902-1137
(321) 952-9696
(321) 952-7937
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
688693129
—
FL
Enumeration date
10/25/2022
Last updated
10/25/2022
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