Provider Demographics
NPI:1316999444
Name:BRISCOE, HOLLY R (RN, CPNP)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:R
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12655 N CENTRAL EXPY
Mailing Address - Street 2:300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1700
Mailing Address - Country:US
Mailing Address - Phone:972-788-1858
Mailing Address - Fax:972-788-2798
Practice Address - Street 1:12655 N CENTRAL EXPY
Practice Address - Street 2:300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1700
Practice Address - Country:US
Practice Address - Phone:972-788-1858
Practice Address - Fax:972-788-2798
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669246363LP0200X
CO178932363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics