Provider Demographics
NPI:1053380220
Name:BRIGGS, JONATHAN D (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:D
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SINGLETON RIDGE ROAD
Mailing Address - Street 2:ATTENTION PNS CREDENTIALING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:4300 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9630
Practice Address - Country:US
Practice Address - Phone:843-399-3377
Practice Address - Fax:843-399-3378
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6994Medicaid
NY01503759Medicaid
NYCC8362OtherRR MEDICARE GROUP
J400058072Medicare PIN
NY500001528OtherRR MEDICARE PIN