Provider Demographics
NPI:1689190670
Name:LIEBLA, BRITTANIA ANNE GEORGETTE (MSN, APRN)
Entity type:Individual
Prefix:MRS
First Name:BRITTANIA
Middle Name:ANNE GEORGETTE
Last Name:LIEBLA
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:ANNE GEORGETTE
Other - Last Name:BROCUGLIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 WATERSIDE XING
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1587
Mailing Address - Country:US
Mailing Address - Phone:860-463-1342
Mailing Address - Fax:
Practice Address - Street 1:153 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4592
Practice Address - Country:US
Practice Address - Phone:877-884-3571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT111601163W00000X
CT007186363L00000X
CT7186363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner