Healthcare Provider Details

I. General information

NPI: 1194299339
Provider Name (Legal Business Name): REBECCAH BRISKIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 240
ORLANDO FL
32804-4641
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 240
ORLANDO FL
32804-4641
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-1380
  • Fax: 407-303-1385
Mailing address:
  • Phone: 407-303-1380
  • Fax: 407-303-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number5315210053
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberOS18965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: