Provider Demographics
NPI:1144984246
Name:BRAGGS, PRISCILLA RENEE CARLISLE (MSW)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:RENEE CARLISLE
Last Name:BRAGGS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2854 HARRISON AVE UNIT H
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5053
Mailing Address - Country:US
Mailing Address - Phone:850-896-0658
Mailing Address - Fax:
Practice Address - Street 1:10611 FLORIDA HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321
Practice Address - Country:US
Practice Address - Phone:850-643-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker