Provider Demographics
NPI:1073519179
Name:BRIGGS, PHYLLIS M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:M
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7996 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2241
Mailing Address - Country:US
Mailing Address - Phone:215-728-1411
Mailing Address - Fax:
Practice Address - Street 1:7996 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2241
Practice Address - Country:US
Practice Address - Phone:215-728-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP001639G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395409Medicare PIN