Provider Demographics
NPI:1689645020
Name:BRISCOE, BRAD A (APRN, ACNP-BC, CNS)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:A
Last Name:BRISCOE
Suffix:
Gender:M
Credentials:APRN, ACNP-BC, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 W 8TH ST
Mailing Address - Street 2:P.O. BOX 44008
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-3500
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:3122 NEW BERLIN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-1828
Practice Address - Country:US
Practice Address - Phone:904-633-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1067675363LA2100X
FL2590432363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0036958-00Medicaid