Provider Demographics
NPI:1891938098
Name:STRATHOPOLOUS, BRIDGET AILEEN (FNP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:AILEEN
Last Name:STRATHOPOLOUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:AILEEN
Other - Last Name:SLATTERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 639295 DEPT 92286
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9295
Mailing Address - Country:US
Mailing Address - Phone:248-266-4200
Mailing Address - Fax:
Practice Address - Street 1:4318 WOODCOCK DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228
Practice Address - Country:US
Practice Address - Phone:210-736-4051
Practice Address - Fax:210-736-4051
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX713346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX322176402Medicaid
TX292070YK00Medicare PIN