Active NPI
Breanna Douglas
- Behavior Technician
- Jacksonville, FL
National Provider Identifier
1164243374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-24-395576
- Practice address
- 12724 Gran Bay Pkwy W Ste 410
Jacksonville, FL 32258-9486 - Phone
- (855) 832-6727
- NPI assigned
- Oct 21, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | |||
| Behavior Technician | 106S00000X | RBT-24-395576 | FL | Primary |
Addresses
Primary practice location
12724 Gran Bay Pkwy W Ste 410
Jacksonville, FL 32258-9486
Mailing address
1710 Southern Belle LN
Port Orange, FL 32128-7531
Phone (386) 396-2001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-24-395576 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1729468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733184000000",
"number": "1164243374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1710 SOUTHERN BELLE LN",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321287531",
"telephone_number": "386-396-2001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12724 GRAN BAY PKWY W STE 410",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322589486",
"telephone_number": "855-832-6727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "BREANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-21",
"last_updated": "2024-12-03",
"certification_date": "2024-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-24-395576",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.