Provider Demographics
NPI:1164569307
Name:CANTY, BRIDGET MARY (RN,MS,PNP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARY
Last Name:CANTY
Suffix:
Gender:F
Credentials:RN,MS,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5299 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-1529
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:510-450-5809
Practice Address - Street 1:5299 LAUREL DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-1529
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-450-5809
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417728363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner