Healthcare Provider Details

I. General information

NPI: 1487292058
Provider Name (Legal Business Name): MRS. BRIDGET MARIE HOBART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS BRIDGET MARIE O'ROURKE

II. Dates (important events)

Enumeration Date: 12/14/2019
Last Update Date: 12/14/2019
Certification Date: 12/14/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FAIRWAY DR SUITE 102
DEERFIELD BEACH FL
33441
US

IV. Provider business mailing address

500 FAIRWAY DR SUITE 102
DEERFIELD BEACH FL
33441
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax: 866-500-2186
Mailing address:
  • Phone: 877-418-2978
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: