Healthcare Provider Details

I. General information

NPI: 1871283515
Provider Name (Legal Business Name): BREANA T BESS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 SAINT JOHNS AVE STE 13
JACKSONVILLE FL
32210-1852
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-5222
  • Fax: 904-390-7461
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME171222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: