Healthcare Provider Details

I. General information

NPI: 1033712765
Provider Name (Legal Business Name): BRIDGET STARR GILL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 LIBERTY ST
MEADVILLE PA
16335-2591
US

IV. Provider business mailing address

1034 GROVE ST
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 814-333-7016
  • Fax: 814-373-3543
Mailing address:
  • Phone: 814-333-7016
  • Fax: 814-373-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP022648
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSP022648
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: