Individual
KACIE JUNE BREWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
0110005142
VA
363AS0400X
Surgical Physician Assistant
Primary
PA9107527
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003140599A
—
GA
05
—
003140599B
—
GA
05
—
009664700
—
FL
Enumeration date
09/30/2013
Last updated
11/22/2022
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