Provider Demographics
NPI:1942698287
Name:BRIDGES, BETTY MANNING (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:MANNING
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:BETTY
Other - Middle Name:JEAN
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-778-8513
Mailing Address - Fax:615-628-6877
Practice Address - Street 1:1150 US HIGHWAY 41 NW
Practice Address - Street 2:STE 11&12
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052-5888
Practice Address - Country:US
Practice Address - Phone:386-792-7744
Practice Address - Fax:386-792-7745
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN153273363LA2200X
FLARNP9396092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health