Healthcare Provider Details

I. General information

NPI: 1134947476
Provider Name (Legal Business Name): BRITTANY MACY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W INDIANTOWN RD STE 201
JUPITER FL
33458-3536
US

IV. Provider business mailing address

320 CHAMBERLAIN BLVD
FORT PIERCE FL
34946-1803
US

V. Phone/Fax

Practice location:
  • Phone: 561-436-5996
  • Fax:
Mailing address:
  • Phone: 772-979-1902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11034485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: