Healthcare Provider Details

I. General information

NPI: 1265918015
Provider Name (Legal Business Name): BRITTANY LYNN GREENSPAN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3899
US

IV. Provider business mailing address

PO BOX 658
GAINESVILLE GA
30503-0658
US

V. Phone/Fax

Practice location:
  • Phone: 770-535-3611
  • Fax: 770-535-7092
Mailing address:
  • Phone: 770-533-6511
  • Fax: 770-533-4786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN248614
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN248614
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: