Provider Demographics
NPI:1235648502
Name:BRISCOE, ELISIA RICKARD
Entity Type:Individual
Prefix:
First Name:ELISIA
Middle Name:RICKARD
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8348 LITTLE RD STE 349
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-4919
Mailing Address - Country:US
Mailing Address - Phone:727-741-3405
Mailing Address - Fax:727-213-6246
Practice Address - Street 1:8348 LITTLE RD STE 349
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-4919
Practice Address - Country:US
Practice Address - Phone:727-741-3405
Practice Address - Fax:727-213-6246
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist