Healthcare Provider Details

I. General information

NPI: 1891329355
Provider Name (Legal Business Name): BRITTANI NEWPORT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANI GAGER

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10743 NARCOOSSEE RD STE A13
ORLANDO FL
32832-6946
US

IV. Provider business mailing address

9260 RANDAL PARK BLVD UNIT 15110
ORLANDO FL
32832-4942
US

V. Phone/Fax

Practice location:
  • Phone: 407-736-8733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPRN11006196
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: