Provider Demographics
NPI:1003190745
Name:BRIDGES, TANIS SHARON (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:TANIS
Middle Name:SHARON
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 ELMDORF AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619
Mailing Address - Country:US
Mailing Address - Phone:585-527-8391
Mailing Address - Fax:
Practice Address - Street 1:261 ELMDORF AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619
Practice Address - Country:US
Practice Address - Phone:585-527-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184644-1163W00000X, 163WI0500X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WP0200XNursing Service ProvidersRegistered NursePediatrics