Healthcare Provider Details

I. General information

NPI: 1588911457
Provider Name (Legal Business Name): BRITTA RENZULLI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTA ANDREOZZI

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTERVILLE RD STE 110
WARWICK RI
02886-0200
US

IV. Provider business mailing address

10 DAVOL SQ STE 400
PROVIDENCE RI
02903-4752
US

V. Phone/Fax

Practice location:
  • Phone: 401-615-2299
  • Fax: 401-615-7529
Mailing address:
  • Phone: 401-421-4000
  • Fax: 401-272-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00647
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA00647
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: