Healthcare Provider Details

I. General information

NPI: 1588841977
Provider Name (Legal Business Name): KELLI NICOLE BRIDGMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W PLYMOUTH AVE
DELAND FL
32720-2753
US

IV. Provider business mailing address

201 W PLYMOUTH AVE
DELAND FL
32720-2753
US

V. Phone/Fax

Practice location:
  • Phone: 386-873-2963
  • Fax:
Mailing address:
  • Phone: 386-873-2963
  • Fax: 386-873-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11011937
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPRN11011937
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: