Provider Demographics
NPI:1821186008
Name:BATTLE, BRIDGETTE DEMETRE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:DEMETRE
Last Name:BATTLE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 28665
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-8665
Mailing Address - Country:US
Mailing Address - Phone:904-751-9415
Mailing Address - Fax:904-751-9415
Practice Address - Street 1:853 JEFFERSON AVE # 206
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-448-6728
Practice Address - Fax:901-448-1691
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN13211363LN0000X
MSR856553363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107530AMedicaid
FL0033972-00Medicaid
FLEV210ZMedicare PIN