Provider Demographics
NPI:1023573961
Name:BRIDGES, CANDY (STUDENT)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CANDY HARTMAN
Mailing Address - Street 1:500 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3094
Mailing Address - Country:US
Mailing Address - Phone:863-293-1191
Mailing Address - Fax:
Practice Address - Street 1:200 AVENUE F NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:863-293-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN9185770163WA2000X
FLAPRN11001627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator