Healthcare Provider Details

I. General information

NPI: 1821186008
Provider Name (Legal Business Name): BRIDGETTE DEMETRE BATTLE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 JEFFERSON AVE # 206
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

PO BOX 28665
JACKSONVILLE FL
32226-8665
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6728
  • Fax: 901-448-1691
Mailing address:
  • Phone: 904-751-9415
  • Fax: 904-751-9415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number13211
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberR856553
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: