MEDICARE: BREASIA PIPKIN

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	374J00000X	Doula

General Provider Information

NPI Number	:	1538851365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREASIA PIPKIN

Provider Business Mailing Address
First Line	:	PO BOX 441
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-0441
Country	:	US
Telephone Number	:	863-632-2207
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 E SEMINOLE AVE APT 4
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33853-5709
Country	:	US
Telephone Number	:	863-632-2207
Fax Number	:

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

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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Directions to “ BREASIA PIPKIN ” Practice Location

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