=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255955175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY BRACEWELL FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2020
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 ZEAGLER DR STE 4
-----------------------------------------------------
City | PALATKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32177-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-309-5455
-----------------------------------------------------
Fax | 833-973-5937
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 504 N CHERRY ST
-----------------------------------------------------
City | BUNNELL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32110-6072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-507-3421
-----------------------------------------------------
Fax | 386-243-3049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11007298
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------