Provider Demographics
NPI:1336123579
Name:BRIGHAM, JANE M (CNM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:M
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:2 TAMPA GENERAL CIR
Mailing Address - Street 2:6STC
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3603
Mailing Address - Country:US
Mailing Address - Phone:810-656-4006
Mailing Address - Fax:
Practice Address - Street 1:2 TAMPA GENERAL CIR
Practice Address - Street 2:6STC
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3603
Practice Address - Country:US
Practice Address - Phone:810-656-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704206781367A00000X
FL9399322367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014643000Medicaid
MI4624120Medicaid
MI420B512750OtherBLUE CROSS BLUE SHIELD
MI1010140OtherMCLAREN HEALTH PLAN
MI1010140OtherHEALTH ADVANTAGE NETWORK
MI4638994Medicaid
FLY0R0FOtherBLUE CROSS BLUE SHIELD
FLID026ZMedicare UPIN
MI4638994Medicaid
MIQ10259Medicare UPIN