Provider Demographics
NPI:1679562185
Name:BRIDGES, GLENN A (CRNA)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:A
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1718
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37816-1718
Mailing Address - Country:US
Mailing Address - Phone:423-581-5987
Mailing Address - Fax:423-581-0984
Practice Address - Street 1:1027 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-6632
Practice Address - Country:US
Practice Address - Phone:423-581-5984
Practice Address - Fax:423-581-0984
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000046238367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505737Medicaid
TN3602326Medicaid
TN3150485OtherBCBS
TN3602321Medicare PIN
TN36023201Medicare PIN