Healthcare Provider Details

I. General information

NPI: 1518432483
Provider Name (Legal Business Name): MRS. BRITTNY HEGENAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7225 N NEBRASKA AVE
TAMPA FL
33604-4916
US

IV. Provider business mailing address

424 55TH AVE NE
ST PETERSBURG FL
33703-3018
US

V. Phone/Fax

Practice location:
  • Phone: 813-236-1182
  • Fax:
Mailing address:
  • Phone: 813-841-4834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: