Provider Demographics
NPI:1023572021
Name:BRIDGE, JESSICA M (MSN, CNM, WHNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:BRIDGE
Suffix:
Gender:F
Credentials:MSN, CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 TAMARACK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-5560
Mailing Address - Country:US
Mailing Address - Phone:860-646-1157
Mailing Address - Fax:860-646-9877
Practice Address - Street 1:2600 TAMARACK AVE STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-5560
Practice Address - Country:US
Practice Address - Phone:860-646-1157
Practice Address - Fax:860-646-9877
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACNM05394367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACNM05394OtherAMCB