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NPI Code Detail

MEDICARE: BRITTANY LORIQUET RD

MEDICARE: BRITTANY LORIQUET RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian1083243FL

General Provider Information

NPI Number : 1457861510
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITTANY LORIQUET RD
Provider Business Mailing Address
First Line : 633 E BALDWIN RD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4207
Country : US
Telephone Number : 850-522-5490
Fax Number :
Provider Business Practice Location Address
First Line : 633 E BALDWIN RD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4207
Country : US
Telephone Number : 850-522-5490
Fax Number : 850-522-5491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2017
Last Update Date : 10/03/2017

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Directions to “ BRITTANY LORIQUET RD” Practice Location

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