Provider Demographics
NPI:1912530866
Name:BRIGOLA, REBECCA L (APNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:BRIGOLA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4289 AMBERLEAF WALK
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3158
Mailing Address - Country:US
Mailing Address - Phone:703-405-2325
Mailing Address - Fax:
Practice Address - Street 1:4120 FIVE FORKS TRICKUM RD SW STE 102
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8975
Practice Address - Country:US
Practice Address - Phone:770-923-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN259312363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics