MEDICARE: KATHERINE SZAKAL BRIDGES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9430	GA
2	363A00000X	Physician Assistant	PA9116055	FL

General Provider Information

NPI Number	:	1134779770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SZAKAL BRIDGES PA

Provider Business Mailing Address
First Line	:	2505 HARRISON AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4464
Country	:	US
Telephone Number	:	850-233-3376
Fax Number	:	850-522-8354

Provider Business Practice Location Address
First Line	:	1474 MARKET ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1768
Country	:	US
Telephone Number	:	850-233-3376
Fax Number	:	850-522-8354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	10/11/2022

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