NPIMap

Organization Active NPI

Avia Premier Care LLC

Doing business as Raeon Bryan

  • Behavior Technician
  • Brandon, FL
National Provider Identifier
1881135580
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
103K00000X Issued in FL
Legal business name
AVIA PREMIER CARE LLC
Doing business as
Raeon Bryan
Practice address
309 Providence Rd
Brandon, FL 33511-4761
Phone
(727) 564-0524
NPI assigned
Mar 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Audrey Watson
Title
Ceo
Phone
(813) 438-8276

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 106S00000X 103K00000X FL Primary

Addresses

Primary practice location

309 Providence Rd
Brandon, FL 33511-4761

Mailing address

309 Providence Rd
Brandon, FL 33511-4761

Other identifiers 1

IdentifierTypeStateIssuer
018120200MedicaidFL

Other names 1

  • Raeon Bryan Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Avia Premier Care LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489449600000",
    "number": "1881135580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 PROVIDENCE RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 PROVIDENCE RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114761",
            "telephone_number": "727-564-0524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVIA PREMIER CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-14",
        "last_updated": "2017-03-14",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "813-438-8276"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "103K00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018120200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Raeon Bryan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.