Provider Demographics
NPI:1154928711
Name:MULLIGAN, BRITTANY LEE (CRNA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEE
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:LEE
Other - Last Name:GRIEBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13990 BARTRAM PARK BLVD UNIT 3017
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5582
Mailing Address - Country:US
Mailing Address - Phone:631-926-6159
Mailing Address - Fax:
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8408
Practice Address - Country:US
Practice Address - Phone:631-968-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY686868207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty