Healthcare Provider Details

I. General information

NPI: 1235639725
Provider Name (Legal Business Name): BRITTANIE NIKOL SVOBODA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29640 EUCLID AVE
WICKLIFFE OH
44092-1829
US

IV. Provider business mailing address

500 KIRTS BLVD STE 100
TROY MI
48084-4135
US

V. Phone/Fax

Practice location:
  • Phone: 440-585-2221
  • Fax:
Mailing address:
  • Phone: 248-434-6169
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.022444
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: