Provider Demographics
NPI:1164047957
Name:NETTLES, BRITTANY ELIZABETH GASPAR (APRN)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ELIZABETH GASPAR
Last Name:NETTLES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 KILCHURN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-3871
Mailing Address - Country:US
Mailing Address - Phone:352-283-5690
Mailing Address - Fax:
Practice Address - Street 1:1604 KILCHURN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-3871
Practice Address - Country:US
Practice Address - Phone:352-283-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily