Healthcare Provider Details

I. General information

NPI: 1760683403
Provider Name (Legal Business Name): PAMELA BRIDGHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 ANDREWS AVE
MELBOURNE FL
32935-2701
US

IV. Provider business mailing address

1270 N WICKHAM RD SUITE 16, BOX 122
MELBOURNE FL
32935-8923
US

V. Phone/Fax

Practice location:
  • Phone: 321-255-0988
  • Fax:
Mailing address:
  • Phone: 321-255-0988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN3087082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: