Provider Demographics
NPI:1366403248
Name:BRIDGES, JANE ELLEN (ANP-C)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELLEN
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3080 ADOBE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-6664
Mailing Address - Country:US
Mailing Address - Phone:928-717-0882
Mailing Address - Fax:
Practice Address - Street 1:804 AINSWORTH DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1624
Practice Address - Country:US
Practice Address - Phone:928-778-1736
Practice Address - Fax:928-717-0785
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN127822363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health