Healthcare Provider Details

I. General information

NPI: 1710697370
Provider Name (Legal Business Name): BRITTANY BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WOODCREST DR APT 410
SAINT AUGUSTINE FL
32084-8656
US

IV. Provider business mailing address

150 WOODCREST DR APT 410
SAINT AUGUSTINE FL
32084-8656
US

V. Phone/Fax

Practice location:
  • Phone: 904-460-7922
  • Fax:
Mailing address:
  • Phone: 904-460-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberCNA253919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: