MEDICARE: BRIDGETTE A HARRIS LPN

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	164W00000X	Licensed Practical Nurse	PN1068941	FL
2	251G00000X	Community Based Hospice Care Agency	PN1068941	FL
3	343900000X	Non-emergency Medical Transport (VAN)	PN1068941	FL
4	347C00000X	Private Vehicle	PN1068941	FL

General Provider Information

NPI Number	:	1548380033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETTE A HARRIS LPN

Provider Business Mailing Address
First Line	:	6494 NW GROVELAND TER
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-3825
Country	:	US
Telephone Number	:	561-644-4283
Fax Number	:

Provider Business Practice Location Address
First Line	:	6494 NW GROVELAND TER
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-3825
Country	:	US
Telephone Number	:	561-644-4283
Fax Number	:

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	06/11/2012

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