Provider Demographics
NPI:1497967608
Name:BRIDGE, DONNA M (D, MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:BRIDGE
Suffix:
Gender:F
Credentials:D, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 8TH AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4000
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:1515 26TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-7707
Practice Address - Country:US
Practice Address - Phone:941-708-8600
Practice Address - Fax:941-708-7645
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003608500Medicaid