Individual
JACQUELINE BREANN STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4708 ALLIANCE BLVD STE 750, PLANO, TX 75093-5354
(972) 562-5999
(972) 562-9755
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-2987
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
TX
363AM0700X
Medical Physician Assistant
PA11198
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
368884801
—
TX
01
—
P01833670
RAILROAD
TX
Enumeration date
02/23/2017
Last updated
12/05/2023
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