Provider Demographics
NPI:1346870409
Name:GUSTAVSON, BRITTANY SHALAIGH (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:SHALAIGH
Last Name:GUSTAVSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:SHALAIGH
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1021 SILVER BLUFF RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5879
Practice Address - Country:US
Practice Address - Phone:803-648-0587
Practice Address - Fax:803-648-9846
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN228242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily