Healthcare Provider Details

I. General information

NPI: 1710362330
Provider Name (Legal Business Name): BRITTANY LAUREN DEITZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0254
US

IV. Provider business mailing address

PO BOX 8500
PINEHURST NC
28374-8500
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8610
  • Fax:
Mailing address:
  • Phone: 910-715-1000
  • Fax: 910-715-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number245806
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9476925
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: