Healthcare Provider Details

I. General information

NPI: 1962035634
Provider Name (Legal Business Name): BRIDGETTE REID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MIRANDA LN STE 131
KISSIMMEE FL
34741-0771
US

IV. Provider business mailing address

2505 BLOWING BREEZE AVE
KISSIMMEE FL
34744-6157
US

V. Phone/Fax

Practice location:
  • Phone: 689-333-0303
  • Fax:
Mailing address:
  • Phone: 914-450-2717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number11005579
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11005579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: