Provider Demographics
NPI:1598260184
Name:OGIEMWANYE, BRIDGET (ARNP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:OGIEMWANYE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19640 NE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3521
Mailing Address - Country:US
Mailing Address - Phone:305-788-9445
Mailing Address - Fax:
Practice Address - Street 1:960 JOHNSON FERRY RD STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1630
Practice Address - Country:US
Practice Address - Phone:404-257-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA253656363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care