Provider Demographics
NPI:1477166635
Name:SANDS, BRIDGETT MICHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:MICHELLE
Last Name:SANDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 VICTORIA PARK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5611
Mailing Address - Country:US
Mailing Address - Phone:904-762-6333
Mailing Address - Fax:
Practice Address - Street 1:3165 VICTORIA PARK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5611
Practice Address - Country:US
Practice Address - Phone:904-762-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily