1437713633 NPI number — MS. RENAE B BRIDGES APRN

Table of content: MS. RENAE B BRIDGES APRN (NPI 1437713633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437713633 NPI number — MS. RENAE B BRIDGES APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIDGES
Provider First Name:
RENAE
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERRY
Provider Other First Name:
RENAE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437713633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1335 SLIGH BLVD
Provider Second Line Business Mailing Address:
STE 3
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806-1110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-841-9025
Provider Business Mailing Address Fax Number:
321-842-3651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1335 SLIGH BLVD
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32806-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-841-9025
Provider Business Practice Location Address Fax Number:
321-842-3651
Provider Enumeration Date:
04/24/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  AP141454 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: APRN11004171 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AG03190028 . This is a "AANP" identifier . This identifiers is of the category "OTHER".
  • Identifier: AP141454 . This is a "APRN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 110639700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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