Provider Demographics
NPI:1144258039
Name:GREENE, BRIGGS D (PA-C)
Entity type:Individual
Prefix:
First Name:BRIGGS
Middle Name:D
Last Name:GREENE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 SE 17TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9190
Mailing Address - Country:US
Mailing Address - Phone:352-690-2171
Mailing Address - Fax:352-690-6954
Practice Address - Street 1:1511 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6505
Practice Address - Country:US
Practice Address - Phone:352-867-8311
Practice Address - Fax:352-867-1053
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2997363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
33803AOtherGROUP MEDICARE NUMBER
FL290201100Medicaid
FLE0968OtherBCBS FL
FL230482OtherAMERIGROUP
FL230482OtherAMERIGROUP
FL970018006Medicare PIN
FLE0968UMedicare PIN
33803AOtherGROUP MEDICARE NUMBER
FLE0968YMedicare PIN
FLE0968XMedicare PIN
FLE0968VMedicare PIN
FL290201100Medicaid
FLE0968ZMedicare PIN