Provider Demographics
NPI:1134526262
Name:BITTLE, POLLY A (APRN)
Entity type:Individual
Prefix:MS
First Name:POLLY
Middle Name:A
Last Name:BITTLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1402
Mailing Address - Country:US
Mailing Address - Phone:813-353-8775
Mailing Address - Fax:813-353-3956
Practice Address - Street 1:4912 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1402
Practice Address - Country:US
Practice Address - Phone:813-353-8775
Practice Address - Fax:813-353-3956
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1609292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY02S7OtherBCBS
FL014643700Medicaid
FL014643700Medicaid