Provider Demographics
NPI:1225128465
Name:COLLINS-BRIDE, GERALDINE MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:MARIE
Last Name:COLLINS-BRIDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1545 DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-3400
Mailing Address - Country:US
Mailing Address - Phone:415-353-7900
Mailing Address - Fax:415-353-2405
Practice Address - Street 1:1545 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-3400
Practice Address - Country:US
Practice Address - Phone:415-353-7900
Practice Address - Fax:415-353-2405
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB309898363L00000X, 363LC1500X, 363LP0808X, 363LP2300X, 363LA2200X
CANP1406363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS75168Medicare UPIN