Provider Demographics
NPI:1205982105
Name:SMITH, BRIDGET JEAN (FNP)
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:JEAN
Other - Last Name:ROCHELEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2699 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2710
Mailing Address - Country:US
Mailing Address - Phone:562-426-3333
Mailing Address - Fax:562-989-2107
Practice Address - Street 1:2699 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2710
Practice Address - Country:US
Practice Address - Phone:562-426-3333
Practice Address - Fax:562-989-2107
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP16467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP16467OtherNURSE PRACTITIONER LICENS