Provider Demographics
NPI:1538851365
Name:PIPKIN, BREASIA
Entity type:Individual
Prefix:
First Name:BREASIA
Middle Name:
Last Name:PIPKIN
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:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-0441
Mailing Address - Country:US
Mailing Address - Phone:863-632-2207
Mailing Address - Fax:
Practice Address - Street 1:230 E SEMINOLE AVE APT 4
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-5709
Practice Address - Country:US
Practice Address - Phone:863-632-2207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula