Healthcare Provider Details

I. General information

NPI: 1366917007
Provider Name (Legal Business Name): BRIANNA INGEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

IV. Provider business mailing address

3126 KERNAN LAKE CIR APT 304
JACKSONVILLE FL
32246-4292
US

V. Phone/Fax

Practice location:
  • Phone: 978-766-7971
  • Fax:
Mailing address:
  • Phone: 978-766-7971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN224797
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9418661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: