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Individual

BREANCIA OWENS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
9550 US HIGHWAY 19, PORT RICHEY, FL 34668-4664
(727) 494-7609
Mailing address
2109 KING AVE, LAKELAND, FL 33803-2856
(786) 598-6075

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7274947609
FL
Enumeration date
12/05/2022
Last updated
12/05/2022
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