Provider Demographics
NPI:1972866010
Name:BELLANT, AUDREY M (DO)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:M
Last Name:BELLANT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-2427
Mailing Address - Country:US
Mailing Address - Phone:352-799-7000
Mailing Address - Fax:352-799-7077
Practice Address - Street 1:959 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2427
Practice Address - Country:US
Practice Address - Phone:352-799-7000
Practice Address - Fax:352-799-7077
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3111207Q00000X
FLOS12436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine