Provider Demographics
NPI:1194494351
Name:AGEE, BRIDGETTE DENISE (APRN)
Entity type:Individual
Prefix:MS
First Name:BRIDGETTE
Middle Name:DENISE
Last Name:AGEE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5112 SUMMER BROOKE LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2679
Mailing Address - Country:US
Mailing Address - Phone:863-712-2041
Mailing Address - Fax:
Practice Address - Street 1:5112 SUMMER BROOKE LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-2679
Practice Address - Country:US
Practice Address - Phone:863-712-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN110151262084P0800X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry