Provider Demographics
NPI:1518016799
Name:BRIGGS, JUDITH LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNN
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:LYNN
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 TROY ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1757
Mailing Address - Country:US
Mailing Address - Phone:860-748-5721
Mailing Address - Fax:
Practice Address - Street 1:29 TROY ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1757
Practice Address - Country:US
Practice Address - Phone:860-748-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP 90903Medicare UPIN