Provider Demographics
NPI:1720813793
Name:DOCK, BRITTANY DANIELLE
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DANIELLE
Last Name:DOCK
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 1:1163 N WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4931
Mailing Address - Country:US
Mailing Address - Phone:909-241-5171
Mailing Address - Fax:
Practice Address - Street 1:1163 N WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4931
Practice Address - Country:US
Practice Address - Phone:909-241-5171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ248516163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine