Provider Demographics
NPI:1093372419
Name:BRIDGES, DOMINIQUE ELANE
Entity Type:Individual
Prefix:PROF
First Name:DOMINIQUE
Middle Name:ELANE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 EVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76119-7321
Mailing Address - Country:US
Mailing Address - Phone:214-864-0764
Mailing Address - Fax:
Practice Address - Street 1:6508 EVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76119-7321
Practice Address - Country:US
Practice Address - Phone:214-864-0764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant