Provider Demographics
NPI:1700376647
Name:BRUNSON, BRITTNEY LEIGH
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:LEIGH
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 23RD AVE APT 1303
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-6278
Mailing Address - Country:US
Mailing Address - Phone:352-361-6783
Mailing Address - Fax:
Practice Address - Street 1:100 NW 23RD AVE APT 1303
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-6278
Practice Address - Country:US
Practice Address - Phone:352-361-6783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL356483374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty