Individual
BREANNA EVE TAPHOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AT
Contact information
Practice address
401 W KENNEDY BLVD, TAMPA, FL 33606-1450
(111) 111-1111
Mailing address
401 W KENNEDY BLVD, TAMPA, FL 33606-1450
(111) 111-1111
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
12/04/2018
Last updated
12/04/2018
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