Healthcare Provider Details

I. General information

NPI: 1326444712
Provider Name (Legal Business Name): BRITTANY EBERLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 N HONORE AVE STE 210
SARASOTA FL
34243-2657
US

IV. Provider business mailing address

5911 N HONORE AVE STE 210
SARASOTA FL
34243-2657
US

V. Phone/Fax

Practice location:
  • Phone: 941-308-7546
  • Fax: 941-308-7550
Mailing address:
  • Phone: 941-308-7546
  • Fax: 941-308-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0005605
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9111226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: