Provider Demographics
NPI:1861702987
Name:SCHLATTNER, BRIDGET ELIZABETH
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:ELIZABETH
Last Name:SCHLATTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BARBAROSA STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-0331
Mailing Address - Country:US
Mailing Address - Phone:904-325-1113
Mailing Address - Fax:
Practice Address - Street 1:112 BARBAROSA STREET
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-0331
Practice Address - Country:US
Practice Address - Phone:904-325-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686237301Medicaid
FL686237396Medicaid