Provider Demographics
NPI:1720710171
Name:SBB FIT 4 LIFE
Entity Type:Organization
Organization Name:SBB FIT 4 LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-470-9142
Mailing Address - Street 1:7522 GILLEY TER
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3703
Mailing Address - Country:US
Mailing Address - Phone:443-470-9142
Mailing Address - Fax:
Practice Address - Street 1:7522 GILLEY TER
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3703
Practice Address - Country:US
Practice Address - Phone:443-470-9142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty