Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | BP10054196 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | R5427 | TX |
NPI | 1184002891 |
---|---|
Provider Name | Brittany Lynne Love |
First Address | Fort Worth, TX 76107-2553 |
Second Address | Fort Worth, TX 76107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2015 |
Last Update Date | 08/10/2019 |