Healthcare Provider Details

I. General information

NPI: 1528416401
Provider Name (Legal Business Name): KRISTIN ELIZABETH BRISCOE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 12/18/2021
Certification Date: 12/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 KINGSLEY AVE STE 1500
ORANGE PARK FL
32073-4481
US

IV. Provider business mailing address

4400 W 95TH ST STE 205
OAK LAWN IL
60453-2658
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-0880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberTRN23323
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME145353
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number036155288
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: