Healthcare Provider Details

I. General information

NPI: 1710658323
Provider Name (Legal Business Name): BRIANNA MARIE FEBUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 LAKE UNDERHILL RD
ORLANDO FL
32828-4507
US

IV. Provider business mailing address

13836 DOVE WING CT
ORLANDO FL
32828-7470
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4039
  • Fax:
Mailing address:
  • Phone: 321-972-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: