Healthcare Provider Details

I. General information

NPI: 1003079906
Provider Name (Legal Business Name): BRIDGET SHOULDERS-ODOM MS, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLD
TAMPA FL
33612
US

IV. Provider business mailing address

31047 WHITLOCK DR
WESLEY CHAPEL FL
33543-3942
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2000
  • Fax:
Mailing address:
  • Phone: 813-383-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2068242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: