Provider Demographics
NPI:1558853523
Name:CALDERON, BRIDGETTE S (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:S
Last Name:CALDERON
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3443
Mailing Address - Country:US
Mailing Address - Phone:516-717-1839
Mailing Address - Fax:631-204-6446
Practice Address - Street 1:120 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3443
Practice Address - Country:US
Practice Address - Phone:516-717-1839
Practice Address - Fax:631-204-6446
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343017-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily