Provider Demographics
NPI:1184369555
Name:PELLERAN, BRITTANY (AG-ACNP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:PELLERAN
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2099
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85372-2099
Mailing Address - Country:US
Mailing Address - Phone:623-377-7410
Mailing Address - Fax:
Practice Address - Street 1:10474 W THUNDERBIRD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3015
Practice Address - Country:US
Practice Address - Phone:623-377-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274320363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty