Provider Demographics
NPI:1053176305
Name:GRAGG, BRITTANEY NICOLE
Entity type:Individual
Prefix:
First Name:BRITTANEY
Middle Name:NICOLE
Last Name:GRAGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7742 MINNIE ROUSE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5112
Mailing Address - Country:US
Mailing Address - Phone:706-201-7333
Mailing Address - Fax:
Practice Address - Street 1:12004 BURTON ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8853
Practice Address - Country:US
Practice Address - Phone:706-201-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist