Provider Demographics
NPI:1366135717
Name:HALLOCK, BRITTANY LYNN
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LYNN
Last Name:HALLOCK
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 1:2 SENECA TRL
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-3418
Mailing Address - Country:US
Mailing Address - Phone:973-634-6709
Mailing Address - Fax:
Practice Address - Street 1:2 SENECA TRL
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-3418
Practice Address - Country:US
Practice Address - Phone:973-634-6709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2022002946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily