Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Breanna Douglas

Individual provider Other Technician · NPI 1164243374

Breanna Douglas is an Other Technician in Jacksonville, Florida. Licensed in Florida. Registered with an NPI since 2024.

Licensed in
FL
In the registry since
2024
Specialties on file
2

Practice location Address checks out

12724 Gran Bay Pkwy W Ste 410
Jacksonville, FL 32258-9486
Phone: (855) 832-6727
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Technician (primary) Taxonomy 106S00000X · Licence RBT-24-395576 (FL)
Other Technician Taxonomy 247200000X

Record details

NPI number1164243374
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 21, 2024
Last updated in NPPESDecember 3, 2024
Certification dateDecember 3, 2024
Mailing address1710 Southern Belle Ln, Port Orange, FL 32128-7531

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