Provider Demographics
NPI:1942774302
Name:STREVIG, BREANNA LEIGH JOY
Entity Type:Individual
Prefix:MS
First Name:BREANNA
Middle Name:LEIGH JOY
Last Name:STREVIG
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 1:9141 CYPRESS GREEN DR STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2006
Mailing Address - Country:US
Mailing Address - Phone:904-647-1849
Mailing Address - Fax:
Practice Address - Street 1:9141 CYPRESS GREEN DR STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-647-1849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician