Healthcare Provider Details

I. General information

NPI: 1508664483
Provider Name (Legal Business Name): BRIANNA M GREGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK PLACE BLVD
KISSIMMEE FL
34741-2358
US

IV. Provider business mailing address

4113 S SEMORAN BLVD
ORLANDO FL
32822-2468
US

V. Phone/Fax

Practice location:
  • Phone: 407-385-0728
  • Fax:
Mailing address:
  • Phone: 781-980-8253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-416428
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: