Provider Demographics
NPI:1144656141
Name:BRISCOE, TARABETH MARIE (LPN)
Entity type:Individual
Prefix:
First Name:TARABETH
Middle Name:MARIE
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2014
Mailing Address - Country:US
Mailing Address - Phone:631-286-2784
Mailing Address - Fax:
Practice Address - Street 1:20 SUSAN DR
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2014
Practice Address - Country:US
Practice Address - Phone:631-286-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260462164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse