Healthcare Provider Details

I. General information

NPI: 1427960756
Provider Name (Legal Business Name): BRE-ANNA LYN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 HENDERSON RD
TAMPA FL
33634-1143
US

IV. Provider business mailing address

4391 LEEWARD RIDGE DR APT 205
TAMPA FL
33619-6844
US

V. Phone/Fax

Practice location:
  • Phone: 813-816-5917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: