Healthcare Provider Details

I. General information

NPI: 1255277612
Provider Name (Legal Business Name): BRIDGETTE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 WILKENS AVE
BALTIMORE MD
21229-5213
US

IV. Provider business mailing address

5933 HARPERS FARM RD
COLUMBIA MD
21044-3007
US

V. Phone/Fax

Practice location:
  • Phone: 443-763-1404
  • Fax:
Mailing address:
  • Phone: 443-763-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP57634
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: