1164584124 NPI number — HEATHER N BRITTON

Table of content: HEATHER N BRITTON (NPI 1164584124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164584124 NPI number — HEATHER N BRITTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRITTON
Provider First Name:
HEATHER
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164584124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9960 NW 116TH WAY
Provider Second Line Business Mailing Address:
SUITE 13
Provider Business Mailing Address City Name:
MEDLEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33178-1167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-924-1311
Provider Business Mailing Address Fax Number:
786-924-1313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 N STATE RD 7
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
MARGATE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33063-5737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-979-1212
Provider Business Practice Location Address Fax Number:
954-979-1951
Provider Enumeration Date:
12/15/2006

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: 2084N0400X , with the licence number:  ME85936 , 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)

  • Identifier: N245643 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N245643 . This is a "STAYWELL HEALTH PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 47834 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N245643 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 266903000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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