Provider Demographics
NPI:1063962892
Name:BRIDGEMAN, VANESSA DANG (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:DANG
Last Name:BRIDGEMAN
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 MCKENDREE CHURCH RD # 800
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4107
Mailing Address - Country:US
Mailing Address - Phone:470-210-7766
Mailing Address - Fax:
Practice Address - Street 1:1670 MCKENDREE CHURCH RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4107
Practice Address - Country:US
Practice Address - Phone:470-210-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN206292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily