Healthcare Provider Details

I. General information

NPI: 1023622107
Provider Name (Legal Business Name): BREANNA MARIE YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 US HIGHWAY 27 N
SEBRING FL
33870-1642
US

IV. Provider business mailing address

3619 US HIGHWAY 27 N
SEBRING FL
33870-1642
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-5624
  • Fax: 863-402-5627
Mailing address:
  • Phone: 863-402-5624
  • Fax: 863-402-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: