Provider Demographics
NPI:1114215878
Name:BRIGGS, STEPHANIE A (LMT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:A
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:HORNUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12795 SAN JOSE BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8676
Mailing Address - Country:US
Mailing Address - Phone:904-619-1587
Mailing Address - Fax:904-328-3763
Practice Address - Street 1:12795 SAN JOSE BLVD STE 9
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8676
Practice Address - Country:US
Practice Address - Phone:904-619-1587
Practice Address - Fax:904-328-3763
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59001225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist