Provider Demographics
NPI:1750750519
Name:ROSCOE, BRIDGET RUDOLPH
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:RUDOLPH
Last Name:ROSCOE
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 1:2090 COLUMBIANA RD
Mailing Address - Street 2:STE 4000
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2153
Mailing Address - Country:US
Mailing Address - Phone:205-536-8400
Mailing Address - Fax:
Practice Address - Street 1:2090 COLUMBIANA RD
Practice Address - Street 2:STE 4000
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-2153
Practice Address - Country:US
Practice Address - Phone:205-536-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127564363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health