Provider Demographics
NPI:1205399227
Name:REA, BRITTANY FOWLER ASHLYN (MD)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:FOWLER ASHLYN
Last Name:REA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:ASHLYN
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 TAMPA GENERAL CIR # J342
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3571
Mailing Address - Country:US
Mailing Address - Phone:813-259-8515
Mailing Address - Fax:
Practice Address - Street 1:1 TAMPA GENERAL CIR # J342
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-250-2111
Practice Address - Fax:203-863-3924
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1512762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program