Individual
MS. BREUNNA JA'MYREA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1443 PRO SHOP CT, CHAMPIONS GATE, FL 33896-8301
(407) 988-7914
Mailing address
1443 PRO SHOP CT, CHAMPIONS GATE, FL 33896-8301
(407) 988-7914
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92-0843535
—
FL
Enumeration date
12/05/2022
Last updated
12/05/2022
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