Provider Demographics
NPI:1417365115
Name:TOVAR, BRITTANY ROSE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ROSE
Last Name:TOVAR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:ROSE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6002
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58206-6002
Mailing Address - Country:US
Mailing Address - Phone:701-780-5000
Mailing Address - Fax:218-784-3855
Practice Address - Street 1:1000 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58206-6002
Practice Address - Country:US
Practice Address - Phone:701-780-5000
Practice Address - Fax:218-784-3855
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR180858-6363LF0000X
NDR37482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1417365115Medicaid