Provider Demographics
NPI:1124539572
Name:DIAKUN, BRIDGET C (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:C
Last Name:DIAKUN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:C
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 WITTON CT APT 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6412
Mailing Address - Country:US
Mailing Address - Phone:860-707-5715
Mailing Address - Fax:
Practice Address - Street 1:1800 TIMBERWOOD BLVD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7544
Practice Address - Country:US
Practice Address - Phone:434-305-0501
Practice Address - Fax:844-429-0456
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002109363LF0000X
DCRN1026441363LF0000X
VA0024177321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily