Provider Demographics
NPI:1821364407
Name:BRIDGETT, MICHAEL WAYNE (CRNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:BRIDGETT
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 SOLOMONS ISLAND RD N
Mailing Address - Street 2:PO BOX 980
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3917
Mailing Address - Country:US
Mailing Address - Phone:410-535-5400
Mailing Address - Fax:410-535-5285
Practice Address - Street 1:975 SOLOMONS ISLAND RD N
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3917
Practice Address - Country:US
Practice Address - Phone:410-535-5400
Practice Address - Fax:410-535-5285
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR096847363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology