Provider Demographics
NPI:1871152769
Name:ROBERTS, BRITTNEY (PA)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 TREMAINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2509
Mailing Address - Country:US
Mailing Address - Phone:567-803-0425
Mailing Address - Fax:
Practice Address - Street 1:2627 TREMAINSVILLE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2509
Practice Address - Country:US
Practice Address - Phone:567-803-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009779363AM0700X
OH50.006015363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical