Healthcare Provider Details

I. General information

NPI: 1104509876
Provider Name (Legal Business Name): BRITTNEY ABIGIAL FALCONER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 E BURLEIGH BLVD
TAVARES FL
32778
US

IV. Provider business mailing address

1418 E BURLEIGH BLVD
TAVARES FL
32778
US

V. Phone/Fax

Practice location:
  • Phone: 352-508-4030
  • Fax:
Mailing address:
  • Phone: 352-508-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11029536
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: