1023675907 NPI number — MRS. BRITTANY CHRISTIN PETRILLI DO

Table of content: MRS. BRITTANY CHRISTIN PETRILLI DO (NPI 1023675907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023675907 NPI number — MRS. BRITTANY CHRISTIN PETRILLI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETRILLI
Provider First Name:
BRITTANY
Provider Middle Name:
CHRISTIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POLO
Provider Other First Name:
BRITTANY
Provider Other Middle Name:
CHRISTIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023675907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2995 DREW ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33759-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-532-0002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4427 W KENNEDY BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-2059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-288-1001
Provider Business Practice Location Address Fax Number:
813-605-6271
Provider Enumeration Date:
05/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS23796 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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