Provider Demographics
NPI:1548037682
Name:LIGHTFOOT, BLIDGIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:BLIDGIE
Middle Name:
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NW 33RD LN
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-1381
Mailing Address - Country:US
Mailing Address - Phone:786-398-3850
Mailing Address - Fax:
Practice Address - Street 1:9111 PARK DR
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-3159
Practice Address - Country:US
Practice Address - Phone:305-756-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily