Provider Demographics
NPI:1982680435
Name:KINANE, BRIDGET M (PA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:KINANE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 75TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3201
Mailing Address - Country:US
Mailing Address - Phone:941-761-1998
Mailing Address - Fax:
Practice Address - Street 1:315 75TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3201
Practice Address - Country:US
Practice Address - Phone:941-761-1616
Practice Address - Fax:941-761-3807
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101156363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
970026428OtherRAILROAD MEDICARE
FL291574000Medicaid
P00121613OtherRAILROAD MEDICARE
970026428OtherRAILROAD MEDICARE
S97852Medicare UPIN
FLE3553VMedicare PIN