Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP 9248091 | FL |
NPI | 1003359076 |
---|---|
Provider Name | Geralde St Surin Bridges |
First Address | Lake Worth, FL 33463-7427 |
Second Address | Lake Worth, FL 33463-7427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2016 |
Last Update Date | 23/11/2016 |