Healthcare Provider Details

I. General information

NPI: 1316337058
Provider Name (Legal Business Name): BRITTANY NUNEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOLLYWOOD BLVD SW
FORT WALTON BEACH FL
32548-4893
US

IV. Provider business mailing address

2243 TOM ST
NAVARRE FL
32566-3343
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-7411
  • Fax:
Mailing address:
  • Phone: 516-330-1679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ9332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: