Provider Demographics
NPI:1548380033
Name:HARRIS, BRIDGETTE A (LPN)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6494 NW GROVELAND TER
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3825
Mailing Address - Country:US
Mailing Address - Phone:561-644-4283
Mailing Address - Fax:
Practice Address - Street 1:6494 NW GROVELAND TER
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3825
Practice Address - Country:US
Practice Address - Phone:561-644-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1068941164W00000X, 251G00000X, 343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251G00000XAgenciesHospice Care, Community Based
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20-4152014OtherEIN