Provider Demographics
NPI:1720766520
Name:BREARY, JAHSELAH
Entity Type:Individual
Prefix:
First Name:JAHSELAH
Middle Name:
Last Name:BREARY
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 1:1324 PRINCE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-7377
Mailing Address - Country:US
Mailing Address - Phone:904-729-9800
Mailing Address - Fax:
Practice Address - Street 1:1324 PRINCE ST APT 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-7377
Practice Address - Country:US
Practice Address - Phone:904-729-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL706374U00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide