Provider Demographics
NPI:1003086083
Name:BROWN, BRIDGETT B
Entity type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:B
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E PEARL ST
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-9002
Mailing Address - Country:US
Mailing Address - Phone:352-394-3689
Mailing Address - Fax:352-394-3689
Practice Address - Street 1:313 E PEARL ST
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-9002
Practice Address - Country:US
Practice Address - Phone:352-394-3689
Practice Address - Fax:352-394-3689
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor