Provider Demographics
NPI:1588739577
Name:LOOMIS, BRIANNE N (AUD)
Entity type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:N
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:BRIANNE
Other - Middle Name:NOELLE
Other - Last Name:BOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:10140 CENTURION PKWY N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-4100
Mailing Address - Fax:
Practice Address - Street 1:1717 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2944
Practice Address - Country:US
Practice Address - Phone:407-650-7000
Practice Address - Fax:407-567-5924
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1667231H00000X
TN1471231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4186157OtherBCBS OF TENNESSEE
TN4186157OtherBCBS OF TENNESSEE