Healthcare Provider Details

I. General information

NPI: 1700105673
Provider Name (Legal Business Name): ELAINE DIANE BRIGGS DNP,APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10895 GREENLEFE DR
ROLLA MO
65401-7403
US

IV. Provider business mailing address

13280 EVENING CREEK DR S STE 225
SAN DIEGO CA
92128-4664
US

V. Phone/Fax

Practice location:
  • Phone: 573-368-1861
  • Fax:
Mailing address:
  • Phone: 877-257-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010014013
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: