Healthcare Provider Details

I. General information

NPI: 1376370940
Provider Name (Legal Business Name): BRITTANY NICOLE EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

4229 NW 29TH TER
GAINESVILLE FL
32605-1517
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9120
  • Fax:
Mailing address:
  • Phone: 954-298-3370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11036562
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11036562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: