Individual provider Active NPI

Tamara Brainard, D.O.

  • Dermatology Physician
  • Jacksonville, FL
National Provider Identifier
1083774707
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
16502 Issued in FL
Practice address
2800 Child Street
Jacksonville, FL 32214-0001
Phone
(904) 542-7912
NPI assigned
Dec 11, 2006
Last updated
Aug 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 16502 FL Primary

Addresses

Primary practice location

2800 Child Street
Jacksonville, FL 32214-0001

Mailing address

2800 Child Street
Jacksonville, FL 32214-0001

Other names 1

  • Tamara Middlesworth Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240730001841 FL Practitioner - Dermatology 8820436785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Arizona College of Osteopathic Medicine Mid Western University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aqua Dermatology of Florida, PAGroup PAC ID 1153390414, 184 clinicians

Practice addresses (Care Compare)

6890 Belfort Oaks PL
Jacksonville, FL 32216-6241
Phone (904) 296-1313

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1390
Skin biopsy819

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
16502FLMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Naples Center for Dermatology & Riverchase Dermatology CurrentSince Dec 9, 2024 Accepting new patients
Aqua Dermatology of Florida, PA Dermatology CurrentSince Dec 9, 2024 Accepting new patients

Locations

6890 Belfort Oaks Pl
Jacksonville, FL 32216
Phone (904) 296-1313

9908 Old Saint Augustine Rd
Ste 200
Jacksonville, FL 32257

9905 Old Saint Augustine Rd
Ste 200
Jacksonville, FL 32257
Phone (904) 296-1313

1015 Crosspointe Dr
Naples, FL 34110
Phone (239) 596-9075

14840 Tamiami Trl
North Port, FL 34287
Phone (941) 564-1542

216 Ponte Vedra Park Dr
Ponte Vedra Beach, FL 32082
Phone (904) 296-1313

900 Village Square Xing
Ste 290
West Palm Beach, FL 33410
Phone (239) 313-2517

Interoperability endpoints

  • Direct secure messaging: tbrainard@firstcoastmohs.emadirect.md

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1083774707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 CHILD STREET",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322140001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 CHILD STREET",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322140001",
            "telephone_number": "904-542-7912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAINARD",
        "first_name": "TAMARA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "16502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAMARA",
            "last_name": "MIDDLESWORTH",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.