Provider Demographics
NPI:1043978927
Name:AUSTIN, DESTINEE BRIONTE
Entity Type:Individual
Prefix:
First Name:DESTINEE
Middle Name:BRIONTE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 N ORANGE BLOSSOM TRL APT 104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-1082
Mailing Address - Country:US
Mailing Address - Phone:407-399-2578
Mailing Address - Fax:
Practice Address - Street 1:5230 N ORANGE BLOSSOM TRL APT 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-1082
Practice Address - Country:US
Practice Address - Phone:407-399-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA95825225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist