Provider Demographics
NPI:1992049506
Name:BRIGGS, ASA TAVARES (NP)
Entity type:Individual
Prefix:
First Name:ASA
Middle Name:TAVARES
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:ASA
Other - Middle Name:
Other - Last Name:BRIGGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1007 PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2315
Mailing Address - Country:US
Mailing Address - Phone:864-748-3939
Mailing Address - Fax:877-370-4340
Practice Address - Street 1:1007 PENDLETON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2315
Practice Address - Country:US
Practice Address - Phone:864-748-3939
Practice Address - Fax:877-370-4340
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22987363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6556Medicaid