Provider Demographics
NPI:1528472511
Name:BRISE, JOAN SALOMON (ARNP, PMHNP, AGPCNP)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:SALOMON
Last Name:BRISE
Suffix:
Gender:F
Credentials:ARNP, PMHNP, AGPCNP
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:S
Other - Last Name:BRISE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP, PMHNP, AGPCNP
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-447-7120
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:200 E ROBINSON ST STE 425
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-4347
Practice Address - Country:US
Practice Address - Phone:407-787-9777
Practice Address - Fax:407-583-4988
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9183763363LA2200X, 363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015860800Medicaid