Provider Demographics
NPI:1447776570
Name:TELEPSYCHIATRIC BRIDGE SERVICES
Entity Type:Organization
Organization Name:TELEPSYCHIATRIC BRIDGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:904-686-1512
Mailing Address - Street 1:4300 MARSH LANDING BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1420
Mailing Address - Country:US
Mailing Address - Phone:904-686-1512
Mailing Address - Fax:904-686-2354
Practice Address - Street 1:4300 MARSH LANDING BLVD
Practice Address - Street 2:SUITE #203
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-686-1512
Practice Address - Fax:904-686-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9336567261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)