Provider Demographics
NPI:1790227494
Name:BRIDGMAN, NICOLE A (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:A
Last Name:BRIDGMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:SHAFAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-447-7120
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:6320 OLD WINTER GARDEN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1381
Practice Address - Country:US
Practice Address - Phone:407-290-0555
Practice Address - Fax:407-295-0028
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9309557163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKT224OtherMEDICARE
FL022712300Medicaid