Healthcare Provider Details

I. General information

NPI: 1255301776
Provider Name (Legal Business Name): BRIDGETTE DIANE FERGUSON FNP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 KINKAID RD
ANNAPOLIS MD
21402-1006
US

IV. Provider business mailing address

5609 KAVEH CT
UPPER MARLBORO MD
20772-3681
US

V. Phone/Fax

Practice location:
  • Phone: 410-293-1733
  • Fax:
Mailing address:
  • Phone: 757-553-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR150910
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberR150910
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR150910
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: