MEDICARE: REBECCA L BRIGOLA APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	RN259312	GA

General Provider Information

NPI Number	:	1912530866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA L BRIGOLA APNP

Provider Business Mailing Address
First Line	:	4289 AMBERLEAF WALK
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-3158
Country	:	US
Telephone Number	:	703-405-2325
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 FIVE FORKS TRICKUM RD SW STE 102
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-8975
Country	:	US
Telephone Number	:	770-923-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	11/27/2023

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