Healthcare Provider Details

I. General information

NPI: 1255878773
Provider Name (Legal Business Name): JENNIFER BRIGGS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2017
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 MAIN STREET
SOMERS CT
06071-1825
US

IV. Provider business mailing address

146 MAIN ST
SOMERS CT
06071-1825
US

V. Phone/Fax

Practice location:
  • Phone: 860-749-8018
  • Fax: 860-316-4015
Mailing address:
  • Phone: 860-749-8018
  • Fax: 860-316-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6873
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number6873
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: