MEDICARE: MS. TABITHA VICKIE BRIGGS CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	6113	MN

General Provider Information

NPI Number	:	1881175560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TABITHA VICKIE BRIGGS CNP

Provider Business Mailing Address
First Line	:	5468 VILLAGE CREEK PKWY N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-3153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 SHINGLE CREEK PKWY STE 210I
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2330
Country	:	US
Telephone Number	:	763-656-8813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	08/22/2018

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