Individual
BREONSHAY KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
476 RIVERSIDE AVE, JACKSONVILLE, FL 32202-4912
(214) 937-1219
Mailing address
476 RIVERSIDE AVE, JACKSONVILLE, FL 32202-4912
(214) 937-1219
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123408600
—
FL
Enumeration date
03/29/2024
Last updated
09/11/2025
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