=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881138840
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIDGETTE HARP FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2016
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19646 N 27TH AVE STE 403
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85027-4028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-879-4477
-----------------------------------------------------
Fax | 623-879-4445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9303 N 7TH ST UNIT 4
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85020-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-305-5100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP8670
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------