Provider Demographics
NPI:1760448245
Name:GEORGE, BRIDGET ODONNELL (APN)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:ODONNELL
Last Name:GEORGE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:HERSHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:311 KINGS RIDGE
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-0000
Mailing Address - Country:US
Mailing Address - Phone:931-454-9863
Mailing Address - Fax:
Practice Address - Street 1:1321 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2425
Practice Address - Country:US
Practice Address - Phone:931-728-0772
Practice Address - Fax:931-728-0444
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5896OtherAPN
TN4048794OtherBLUE CROSS BLUE SHIELD
TN3709474Medicaid
TNDA2686OtherRAILROAD MEDICARE
TN3709474Medicaid
TN5896OtherAPN
TN4048794OtherBLUE CROSS BLUE SHIELD