Provider Demographics
NPI:1518679943
Name:GAUSLIN, BRIDGETTE ROSE
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:ROSE
Last Name:GAUSLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 HAZELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7980
Mailing Address - Country:US
Mailing Address - Phone:732-691-3141
Mailing Address - Fax:
Practice Address - Street 1:401 LACEY RD # B
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-1386
Practice Address - Country:US
Practice Address - Phone:732-849-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01411100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health