Provider Demographics
NPI:1932881331
Name:BROWN, BRIDGETT NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13060 N EGYPT SHORES DR
Mailing Address - Street 2:
Mailing Address - City:CREAL SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:62922-3816
Mailing Address - Country:US
Mailing Address - Phone:618-889-4934
Mailing Address - Fax:
Practice Address - Street 1:3111 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2338
Practice Address - Country:US
Practice Address - Phone:618-241-0333
Practice Address - Fax:618-241-0334
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner