Basic Information
Provider Information
NPI: 1033556634
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WARREN
FirstName: BRITTANY
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 86 W UNDERWOOD ST
Address2: SUITE 201
City: ORLANDO
State: FL
PostalCode: 328061110
CountryCode: US
TelephoneNumber: 3218415142
FaxNumber: 4076483686
Practice Location
Address1: 86 W UNDERWOOD ST
Address2: SUITE 201
City: ORLANDO
State: FL
PostalCode: 328061110
CountryCode: US
TelephoneNumber: 3218415142
FaxNumber: 4076483686
Other Information
ProviderEnumerationDate: 05/23/2013
LastUpdateDate: 05/23/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000XTRN18741FLY Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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