Provider Demographics
NPI:1306882139
Name:MORENO, BRIDGET V (NP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:V
Last Name:MORENO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6756 STONYKIRK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2483
Mailing Address - Country:US
Mailing Address - Phone:210-641-0988
Mailing Address - Fax:
Practice Address - Street 1:343 W HOUSTON ST
Practice Address - Street 2:SUITE 725
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2107
Practice Address - Country:US
Practice Address - Phone:210-225-0481
Practice Address - Fax:210-616-2204
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX600172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153374702Medicaid
TX153374702Medicaid