Provider Demographics
NPI:1215222641
Name:BRISCOE, JESSICA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:M
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3770 N GOLDENROD RD
Mailing Address - Street 2:T2032
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8832
Mailing Address - Country:US
Mailing Address - Phone:407-670-0389
Mailing Address - Fax:407-671-2080
Practice Address - Street 1:3770 N GOLDENROD RD
Practice Address - Street 2:T2032
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8832
Practice Address - Country:US
Practice Address - Phone:407-670-0389
Practice Address - Fax:407-671-2080
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist