Provider Demographics
NPI:1740482363
Name:BRIDGEWATER, BRANDY MICHELLE (RN)
Entity type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:MICHELLE
Last Name:BRIDGEWATER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 DORAL COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2606
Mailing Address - Country:US
Mailing Address - Phone:615-662-0844
Mailing Address - Fax:
Practice Address - Street 1:311 23RD AVE N RM 116
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1503
Practice Address - Country:US
Practice Address - Phone:615-340-5647
Practice Address - Fax:615-340-2140
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN135225163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health