MEDICARE: BRIANNE NICOLE BRIDGELAND ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP60033974	WA
2	163W00000X	Registered Nurse	RN00162116	WA

General Provider Information

NPI Number	:	1104070598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNE NICOLE BRIDGELAND ARNP

Provider Business Mailing Address
First Line	:	8659 HAVEN AVE STE 100
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-4893
Country	:	US
Telephone Number	:	909-920-0444
Fax Number	:	909-920-5044

Provider Business Practice Location Address
First Line	:	8659 HAVEN AVE STE 100
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-4893
Country	:	US
Telephone Number	:	909-920-0444
Fax Number	:	909-920-5044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/06/2025

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