Provider Demographics
NPI:1598239410
Name:STAUFFER, BRIDGET (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2138
Mailing Address - Country:US
Mailing Address - Phone:740-566-4621
Mailing Address - Fax:740-566-4622
Practice Address - Street 1:5175 MORSE RD STE 100
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3458
Practice Address - Country:US
Practice Address - Phone:614-454-4808
Practice Address - Fax:614-454-4809
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH50.006164363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program