Provider Demographics
NPI:1164483707
Name:BRITZ, JODY A (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:A
Last Name:BRITZ
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 PINE GROVE AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3500
Mailing Address - Country:US
Mailing Address - Phone:810-987-5500
Mailing Address - Fax:810-987-6321
Practice Address - Street 1:1231 PINE GROVE AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3500
Practice Address - Country:US
Practice Address - Phone:810-987-5500
Practice Address - Fax:810-987-6321
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704168090363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP27820Medicare UPIN