Individual
DELORIS ANN BROCKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LMT
Contact information
Practice address
2946 JEFFERSON ST, MARIANNA, FL 32446-3140
(850) 526-3211
Mailing address
2946 JEFFERSON ST, MARIANNA, FL 32446-3140
(850) 526-3211
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA90046
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8506939625
NON BILLABLE
FL
Enumeration date
07/27/2021
Last updated
07/27/2021
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