Provider Demographics
NPI:1932154473
Name:BRIDGES, JO ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:JO ANN
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7564 MOUNTAIN GROVE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6754
Mailing Address - Country:US
Mailing Address - Phone:865-632-5885
Mailing Address - Fax:865-632-5893
Practice Address - Street 1:7564 MOUNTAIN GROVE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6754
Practice Address - Country:US
Practice Address - Phone:865-632-5885
Practice Address - Fax:865-632-5893
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0106OtherJOHNDEERE
TNTN0106OtherJOHNDEERE
TN204124194OtherTAX ID NUMBER
TNS60548Medicare UPIN