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: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL SIGONELLA PSC 836 BOX NUMBER 2670
FPO AE
09636
US

IV. Provider business mailing address

NAVAL HOSPITAL SIGONELLA PSC 836 BOX 2670
FPO AE
09636
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 TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86150204
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: