Healthcare Provider Details

I. General information

NPI: 1649466202
Provider Name (Legal Business Name): BRIDGIT LASHEA BAILEY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PROSPECT AVE
OXFORD NC
27565-2543
US

IV. Provider business mailing address

2924 DEARBORN DR
DURHAM NC
27704-3427
US

V. Phone/Fax

Practice location:
  • Phone: 919-692-1005
  • Fax:
Mailing address:
  • Phone: 919-220-2649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number6294
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: