Healthcare Provider Details

I. General information

NPI: 1639096126
Provider Name (Legal Business Name): BRITTANY FREDERICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 MONTAGUE ST
TAMPA FL
33626-1801
US

IV. Provider business mailing address

PO BOX 1532
OLDSMAR FL
34677-1532
US

V. Phone/Fax

Practice location:
  • Phone: 813-558-5300
  • Fax:
Mailing address:
  • Phone: 813-992-9137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: