Healthcare Provider Details

I. General information

NPI: 1205530664
Provider Name (Legal Business Name): BRITTANY MARIE AMBROSE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DRIVE RALEIGH BUILDING, SUITE 304
NORFOLK VA
23507
US

IV. Provider business mailing address

3220 PHAIRFIELD ST
BAKERSFIELD CA
93314-9246
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3397
  • Fax:
Mailing address:
  • Phone: 661-201-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: