Healthcare Provider Details

I. General information

NPI: 1013650548
Provider Name (Legal Business Name): BRITTANY KENNEDY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 FL 54
TRINITY FL
34655
US

IV. Provider business mailing address

9330 FL 54
TRINITY FL
34655
US

V. Phone/Fax

Practice location:
  • Phone: 727-834-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number111463
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: