Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH12528 | FL |
NPI | 1356967202 |
---|---|
Provider Name | Brittany Lisa Forrester |
First Address | Oviedo, FL 32765-7275 |
Second Address | Orlando, FL 32826-4741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2020 |
Last Update Date | 17/06/2020 |