1851993711 NPI number — MS. BRITTANY NICOLE ORTH APRN

Table of content: MS. BRITTANY NICOLE ORTH APRN (NPI 1851993711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851993711 NPI number — MS. BRITTANY NICOLE ORTH APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTH
Provider First Name:
BRITTANY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENDERSON
Provider Other First Name:
BRITTANY
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851993711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3922 ARIVA LOOP APT 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33812-4456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-804-1022
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
596 US 27 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33825-2958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-314-8555
Provider Business Practice Location Address Fax Number:
863-453-3400
Provider Enumeration Date:
11/14/2020

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: 363LF0000X , with the licence number:  APRN11010163 , 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: 108881500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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