Provider Demographics
NPI:1891329355
Name:NEWPORT, BRITTANI
Entity Type:Individual
Prefix:
First Name:BRITTANI
Middle Name:
Last Name:NEWPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTANI
Other - Middle Name:
Other - Last Name:GAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9260 RANDAL PARK BLVD UNIT 15110
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-4942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10743 NARCOOSSEE RD STE A13
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6946
Practice Address - Country:US
Practice Address - Phone:407-736-8733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006196208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics