Healthcare Provider Details

I. General information

NPI: 1942408570
Provider Name (Legal Business Name): VANESSA JONES BRISCOE APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 S RIDGEWOOD AVE STE 2008
PORT ORANGE FL
32127-5176
US

IV. Provider business mailing address

3331 TORRE BLVD
NEW SMYRNA BEACH FL
32168-4689
US

V. Phone/Fax

Practice location:
  • Phone: 386-256-3466
  • Fax: 386-238-9239
Mailing address:
  • Phone: 615-554-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9374796
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN9374796
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: