Provider Demographics
NPI:1619725694
Name:HESTER, BRIANNA LYNN (MT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LYNN
Last Name:HESTER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5236 CORD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-3172
Mailing Address - Country:US
Mailing Address - Phone:904-582-9821
Mailing Address - Fax:
Practice Address - Street 1:4465 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4800
Practice Address - Country:US
Practice Address - Phone:904-582-9821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA102453225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty