Provider Demographics
NPI:1265902100
Name:TAPHOUSE, BREANNA EVE (AT)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:EVE
Last Name:TAPHOUSE
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:TAPHOUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AT
Mailing Address - Street 1:401 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1450
Mailing Address - Country:US
Mailing Address - Phone:111-111-1111
Mailing Address - Fax:
Practice Address - Street 1:401 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1450
Practice Address - Country:US
Practice Address - Phone:111-111-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty