Provider Demographics
NPI:1396022646
Name:SMITH, BRITTANY AG (PA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:AG
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-4620
Mailing Address - Fax:850-623-3541
Practice Address - Street 1:5992 BERRYHILL RD
Practice Address - Street 2:STE 302
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-1013
Practice Address - Country:US
Practice Address - Phone:850-416-4620
Practice Address - Fax:850-623-3541
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2016-12-29
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9106291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFP607ZMedicare PIN