Provider Demographics
NPI:1306301353
Name:BRISCOE, JACQUELINE ELANE (RRT)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ELANE
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6032 E 145TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-4092
Mailing Address - Country:US
Mailing Address - Phone:786-290-9828
Mailing Address - Fax:
Practice Address - Street 1:6032 E 145TH ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-4092
Practice Address - Country:US
Practice Address - Phone:786-290-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRRT4409227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered