Provider Demographics
NPI:1497565634
Name:BRISCOE, ROBIN ANTIONETTE
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:ANTIONETTE
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:ANTOINETTE
Other - Last Name:DYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4525 DAVIS AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-5027
Mailing Address - Country:US
Mailing Address - Phone:240-807-6206
Mailing Address - Fax:240-807-6206
Practice Address - Street 1:4525 DAVIS AVE APT 204
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-5027
Practice Address - Country:US
Practice Address - Phone:240-807-6206
Practice Address - Fax:240-807-6206
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000602962251E00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty