Provider Demographics
NPI:1679769194
Name:OLOFSSON, BRITTANY JEANNE (PAC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JEANNE
Last Name:OLOFSSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6099 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-8721
Mailing Address - Country:US
Mailing Address - Phone:352-794-6868
Mailing Address - Fax:352-794-6869
Practice Address - Street 1:6099 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8721
Practice Address - Country:US
Practice Address - Phone:352-794-6868
Practice Address - Fax:352-794-6869
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9104333363AS0400X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT9104333OtherSTATE LICENSE#
FLAH425ZMedicare PIN