Provider Demographics
NPI:1881235679
Name:JERNIGAN, BRITTNEE
Entity type:Individual
Prefix:
First Name:BRITTNEE
Middle Name:
Last Name:JERNIGAN
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 1:263 SW MUSKET PL
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-2142
Mailing Address - Country:US
Mailing Address - Phone:407-415-5735
Mailing Address - Fax:
Practice Address - Street 1:263 SW MUSKET PL
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-2142
Practice Address - Country:US
Practice Address - Phone:407-415-5735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver