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General NPI Number Information
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NPI Number | 1639860653
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Entity Type | Individual
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Provider Name | LAURA ANN BRISBY FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 2190 HIGHWAY 85 N
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City | NICEVILLE
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State | FL
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Zip | 32578-1045
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Country | US
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Telephone | 818-445-1605
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Fax |
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Provider Business Mailing Address
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Address Line | 355 EVERGREEN AVE
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City | NICEVILLE
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State | FL
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Zip | 32578-1129
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Country | US
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Telephone | 818-445-1605
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11026106
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 77797
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License Number State | NM
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