Provider Demographics
NPI:1649371188
Name:BREWER, JEROME STAPLES IV
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:STAPLES
Last Name:BREWER
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 NW 111TH LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-1334
Mailing Address - Country:US
Mailing Address - Phone:352-351-3733
Mailing Address - Fax:
Practice Address - Street 1:2090 NW 111TH LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-1334
Practice Address - Country:US
Practice Address - Phone:352-351-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3161762367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered