Provider Demographics
NPI:1144200056
Name:SAROYA, BRIDGET ELIZABETH TYNER (CPNP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ELIZABETH TYNER
Last Name:SAROYA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1044 N MOZART ST
Mailing Address - Street 2:STE-402
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2789
Mailing Address - Country:US
Mailing Address - Phone:773-292-4501
Mailing Address - Fax:773-292-2613
Practice Address - Street 1:1044 N MOZART ST
Practice Address - Street 2:STE-402
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2789
Practice Address - Country:US
Practice Address - Phone:773-292-4501
Practice Address - Fax:773-292-2613
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHRN305998 NP08460363LP0200X
IL209013607363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2611598Medicaid