Healthcare Provider Details

I. General information

NPI: 1053380220
Provider Name (Legal Business Name): JONATHAN D. BRIGGS FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 HIGHWAY 90
CONWAY SC
29526-9630
US

IV. Provider business mailing address

300 SINGLETON RIDGE ROAD ATTENTION PNS CREDENTIALING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-399-3377
  • Fax: 843-399-3378
Mailing address:
  • Phone: 843-234-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23989
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: