Provider Demographics
NPI:1265842843
Name:BURROUGHS, BRIDGETT (FNP)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HANOVER PL
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4201
Mailing Address - Country:US
Mailing Address - Phone:516-960-8272
Mailing Address - Fax:
Practice Address - Street 1:11 HANOVER PL
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4201
Practice Address - Country:US
Practice Address - Phone:516-960-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338589-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily