Healthcare Provider Details

I. General information

NPI: 1811656374
Provider Name (Legal Business Name): DONTE BRACKETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/05/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL GUANTANAMO BAY PSC 1005 BOX NUMBER 110185
FPO AA
34009
US

IV. Provider business mailing address

NAVAL HOSPITAL GUANTANAMO BAY PSC 1005 BOX 110185
FPO AA
34009
US

V. Phone/Fax

Practice location:
  • Phone: 757-650-1140
  • Fax:
Mailing address:
  • Phone: 757-650-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86150204
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: