Provider Demographics
NPI:1437745262
Name:BRISCOE, JOHN ANTHONY JR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:BRISCOE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3928 FIRST ST SE
Mailing Address - Street 2:204
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032
Mailing Address - Country:US
Mailing Address - Phone:202-417-0979
Mailing Address - Fax:
Practice Address - Street 1:425 MASSACHUSETTS AVE NW APT 910
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-7629
Practice Address - Country:US
Practice Address - Phone:202-417-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant