Provider Demographics
NPI:1154877025
Name:BRINGARDNER, PATRICK TIMOTHY (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:TIMOTHY
Last Name:BRINGARDNER
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2045
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4588
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2045
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4588
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201606922NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR161133OtherNORTH BEND MEDICAL CENTER GROUP MEDICAID
ORR0000WFBTVOtherNORTH BEND MEDICAL CENTER GROUP MEDICARE
OR1407812365OtherNORTH BEND MEDICAL CENTER GROUP NPI
OR93-0635514OtherNORTH BEND MEDICAL CENTER GROUP TAX ID
OR500713885Medicaid
ORP01716857OtherRAILROAD MEDICARE
OR500713885Medicaid