Provider Demographics
NPI:1215375837
Name:MAZZONI, BRIDGET M (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:MAZZONI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:M
Other - Last Name:MOENIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4000 COLISEUM DR STE 200A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5975
Mailing Address - Country:US
Mailing Address - Phone:757-736-1520
Mailing Address - Fax:757-756-5116
Practice Address - Street 1:4000 COLISEUM DR STE 200A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5975
Practice Address - Country:US
Practice Address - Phone:757-736-1520
Practice Address - Fax:757-756-5116
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110000000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant