Healthcare Provider Details

I. General information

NPI: 1346945383
Provider Name (Legal Business Name): BRIANNA IDALIZ AUSTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100294
GAINESVILLE FL
32610-0294
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7943
  • Fax:
Mailing address:
  • Phone: 352-273-7943
  • Fax: 352-294-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: