Healthcare Provider Details

I. General information

NPI: 1033834130
Provider Name (Legal Business Name): BREEZE MOBILE PHLEBOTOMY & MORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 CHURCH ST FL 19
NEW HAVEN CT
06510-2100
US

IV. Provider business mailing address

157 CHURCH ST FL 19
NEW HAVEN CT
06510-2100
US

V. Phone/Fax

Practice location:
  • Phone: 203-584-6033
  • Fax:
Mailing address:
  • Phone: 203-444-4833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: TABISHA JACKSON
Title or Position: CEO/PREDIDENT
Credential:
Phone: 203-584-6033