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General NPI Number Information
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NPI Number | 1780111773
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Entity Type | Individual
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Provider Name | BRIDGET BOVICH PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/08/2021
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Provider Practice Location Address
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Address Line | 6044 DOCTORS PARK
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City | MILTON
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State | FL
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Zip | 32570-5072
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Country | US
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Telephone | 850-226-6801
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Fax |
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Provider Business Mailing Address
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Address Line | 3086 KILLARNEY DR
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City | PACE
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State | FL
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Zip | 32571-8430
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Country | US
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Telephone | 631-379-3067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 020808
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9111095
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License Number State | FL
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