Basic Information
Provider Information
NPI: 1184397341
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BATTON
FirstName: BRITTANY
MiddleName: T
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7108 S KANNER HWY
Address2:  
City: STUART
State: FL
PostalCode: 349977462
CountryCode: US
TelephoneNumber: 8558326727
FaxNumber:  
Practice Location
Address1: 6789 SOUTHPOINT PKWY STE 100
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322168205
CountryCode: US
TelephoneNumber: 9045567330
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/26/2021
LastUpdateDate: 07/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X1-21-53852FLY Behavioral Health & Social Service ProvidersBehavioral Analyst 
106S00000XRBT-20-116160 N    

No ID Information.


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