Healthcare Provider Details

I. General information

NPI: 1912530866
Provider Name (Legal Business Name): REBECCA L BRIGOLA APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 11/27/2023
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 FIVE FORKS TRICKUM RD SW STE 102
LILBURN GA
30047-8975
US

IV. Provider business mailing address

4289 AMBERLEAF WALK
LILBURN GA
30047-3158
US

V. Phone/Fax

Practice location:
  • Phone: 770-923-6400
  • Fax:
Mailing address:
  • Phone: 703-405-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN259312
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: