Provider Demographics
NPI:1427147057
Name:BRIDGES, AMANDA SUE (ACNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SUE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:15825 SHADY GROVE RD 140
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4015
Mailing Address - Country:US
Mailing Address - Phone:301-869-9776
Mailing Address - Fax:301-417-4954
Practice Address - Street 1:5413W CEDAR LN 203C
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1527
Practice Address - Country:US
Practice Address - Phone:301-869-9776
Practice Address - Fax:301-417-4954
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN965237363L00000X
VA0024164209363LA2100X
MDR147528363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037210800Medicaid
DC409208200Medicaid
DCQ15114Medicare UPIN
DC037210800Medicaid