Provider Demographics
NPI:1437713633
Name:BRIDGES, RENAE B (APRN)
Entity type:Individual
Prefix:MS
First Name:RENAE
Middle Name:B
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1335 SLIGH BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:321-841-9025
Mailing Address - Fax:321-842-3651
Practice Address - Street 1:1335 SLIGH BLVD
Practice Address - Street 2:STE 3
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1110
Practice Address - Country:US
Practice Address - Phone:321-841-9025
Practice Address - Fax:321-842-3651
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141454363LG0600X
FLAPRN11004171363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AG03190028OtherAANP
TXAP141454OtherAPRN