Healthcare Provider Details

I. General information

NPI: 1891034690
Provider Name (Legal Business Name): BRITTANY GAGNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date: 04/09/2024
Reactivation Date: 07/21/2026

III. Provider practice location address

1131 SYMONDS AVE
WINTER PARK FL
32789-3707
US

IV. Provider business mailing address

1131 SYMONDS AVE
WINTER PARK FL
32789-3707
US

V. Phone/Fax

Practice location:
  • Phone: 407-790-4531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17796
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: