Provider Demographics
NPI:1831530013
Name:SEALES, BRIDGETTE MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:MARIE
Last Name:SEALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-5136
Mailing Address - Country:US
Mailing Address - Phone:850-505-8970
Mailing Address - Fax:850-505-6288
Practice Address - Street 1:760 EAST AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-5136
Practice Address - Country:US
Practice Address - Phone:850-505-8970
Practice Address - Fax:850-505-6288
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
ALPA.1141363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical