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Organization
AVIA PREMIER CARE LLC
Active
Organization
AVIA PREMIER CARE LLC
Active
Other names
Raeon Bryan
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY WATSON (CEO)
(813) 438-8276
Entity
Organization
Contact information
Practice address
309 PROVIDENCE RD, BRANDON, FL 33511-4761
(727) 564-0524
Mailing address
309 PROVIDENCE RD, BRANDON, FL 33511-4761
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
103K00000X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018120200
—
FL
Enumeration date
03/14/2017
Last updated
03/14/2017
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