Provider Demographics
NPI:1659981728
Name:BRIDDELL, JAMIE (NP-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BRIDDELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TREE FARM CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9109
Mailing Address - Country:US
Mailing Address - Phone:443-928-9650
Mailing Address - Fax:
Practice Address - Street 1:250 N CALVERT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3505
Practice Address - Country:US
Practice Address - Phone:410-332-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164988363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health