Healthcare Provider Details

I. General information

NPI: 1306676432
Provider Name (Legal Business Name): BRITTANY DAWN BOSMA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR STE 100
AUSTIN TX
78731-4298
US

IV. Provider business mailing address

5604 SOUTHWEST PKWY APT 1414
AUSTIN TX
78735-6250
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-8319
  • Fax: 480-712-1305
Mailing address:
  • Phone: 325-227-9618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1099942
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: