Provider Demographics
NPI:1760267769
Name:BAGWELL, BRITTANY LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LYNN
Last Name:BAGWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 SPRING GATE TRL
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-2545
Mailing Address - Country:US
Mailing Address - Phone:770-866-7403
Mailing Address - Fax:
Practice Address - Street 1:1812 US HIGHWAY 441 N STE AAND310B
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1906
Practice Address - Country:US
Practice Address - Phone:863-357-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant