Provider Demographics
NPI:1356083380
Name:BRIDGE, JACQUELINE MAHONY (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MAHONY
Last Name:BRIDGE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CONSTITUTION BLVD S
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4351
Mailing Address - Country:US
Mailing Address - Phone:203-924-7334
Mailing Address - Fax:203-922-0004
Practice Address - Street 1:25 CONSTITUTION BLVD S
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4351
Practice Address - Country:US
Practice Address - Phone:203-924-7334
Practice Address - Fax:203-922-0004
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10727363LF0000X
CT135754163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse