Provider Demographics
NPI:1053873661
Name:ABBOTT, BREANA LYNN (APRN)
Entity type:Individual
Prefix:
First Name:BREANA
Middle Name:LYNN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12503 COLT CT
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4912
Mailing Address - Country:US
Mailing Address - Phone:832-928-0354
Mailing Address - Fax:
Practice Address - Street 1:12503 COLT CT
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4912
Practice Address - Country:US
Practice Address - Phone:832-928-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2024-06-20
Deactivation Date:2023-04-11
Deactivation Code:
Reactivation Date:2023-06-22
Provider Licenses
StateLicense IDTaxonomies
TX913917163W00000X
TX1123745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8329280354OtherRN HOME HEALTH