Healthcare Provider Details

I. General information

NPI: 1063324457
Provider Name (Legal Business Name): BRITTIANY COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 PRINCETON SQUARE BLVD W STE 1
JACKSONVILLE FL
32256-0362
US

IV. Provider business mailing address

6045 BLANK DR
JACKSONVILLE FL
32244-2577
US

V. Phone/Fax

Practice location:
  • Phone: 904-503-5264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29818
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: