Provider Demographics
NPI:1780215913
Name:GREEN, BRITTNEY KEANNA (HEAVEN SENT HOME)
Entity Type:Individual
Prefix:MRS
First Name:BRITTNEY
Middle Name:KEANNA
Last Name:GREEN
Suffix:
Gender:F
Credentials:HEAVEN SENT HOME
Other - Prefix:MRS
Other - First Name:BRITTNEY
Other - Middle Name:KEANNA
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HEAVEN SENT HOME
Mailing Address - Street 1:9420 GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-1212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3037 POST ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6031
Practice Address - Country:US
Practice Address - Phone:904-413-2073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235720376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker