Healthcare Provider Details

I. General information

NPI: 1265712160
Provider Name (Legal Business Name): JONATHAN BRISSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 SHORT BRANCH DR STE 101
TRINITY FL
34655-4426
US

IV. Provider business mailing address

1806 SHORT BRANCH DR STE 101
TRINITY FL
34655-4426
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-0873
  • Fax:
Mailing address:
  • Phone:
  • Fax: 888-402-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS12070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: