Provider Demographics
NPI:1952717613
Name:VENEGAS, BRITTANY OLIPHANT (PA)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:OLIPHANT
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 SW 46TH RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8100
Mailing Address - Country:US
Mailing Address - Phone:727-415-1103
Mailing Address - Fax:
Practice Address - Street 1:8419 SW 46TH RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-8100
Practice Address - Country:US
Practice Address - Phone:727-415-1103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107982363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013047600Medicaid
FL013047600Medicaid