Healthcare Provider Details

I. General information

NPI: 1326506783
Provider Name (Legal Business Name): BRITTANY MAURELLE SMITH FAMILY NURSE PRACTIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FLATBUSH AVENUE EXT
BROOKLYN NY
11201-2903
US

IV. Provider business mailing address

3371 DOGWOOD DR UNIT 140
ATLANTA GA
30354-1488
US

V. Phone/Fax

Practice location:
  • Phone: 212-271-7200
  • Fax:
Mailing address:
  • Phone: 404-357-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number217264
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number217264
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346383-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: