Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 122300000 | FL |
NPI | 1518422294 |
---|---|
Provider Name | Brittany Fennell |
First Address | Jacksonville, FL 32226-1330 |
Second Address | Jacksonville, FL 32226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2019 |
Last Update Date | 06/02/2019 |