Healthcare Provider Details

I. General information

NPI: 1881147064
Provider Name (Legal Business Name): BRITTANY LEBLANC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 LYNDALE BLVD
WINTER PARK FL
32789-2323
US

IV. Provider business mailing address

112 BAY LEAF LN
DAVENPORT FL
33896-4724
US

V. Phone/Fax

Practice location:
  • Phone: 706-594-7535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: