Provider Demographics
NPI:1922648393
Name:DINGLER, BRITTANY JORDAN
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JORDAN
Last Name:DINGLER
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 1:35 RED HILL CIR APT D
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1765
Mailing Address - Country:US
Mailing Address - Phone:860-866-6544
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR STE 110
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2577
Practice Address - Country:US
Practice Address - Phone:707-551-3300
Practice Address - Fax:707-551-3301
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty