Provider Demographics
NPI:1023490174
Name:HOLBROOK, BRIDGET NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:NICOLE
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:NICOLE
Other - Last Name:GERADS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4670 PARK NICOLLET AVE SE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-4119
Practice Address - Country:US
Practice Address - Phone:952-993-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant