MEDICARE: THAMIA BRENDA PIERRE PHILIPPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1346196599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAMIA BRENDA PIERRE PHILIPPE

Provider Business Mailing Address
First Line	:	353 W 11TH ST APT 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-3569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6196 LAKE GRAY BLVD STE 111
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5867
Country	:	US
Telephone Number	:	904-304-3264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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