Bridget Bovich, PA-C

Key facts

NPI

1780111773

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

License

PA9111095 (FL)

Practice address

6044 Doctors Park
Milton, FL 32570-5072

Phone

(850) 226-6801

NPI assigned

May 22, 2017

Sex

Female

Sole proprietor

No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  NPD (past)
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  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Physician Assistant

State licenses

Practice roles

Specialties & licenses

Addresses

Other names

• Bridget Straub Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 8, 2021.

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620432000000",
    "number": "1780111773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3086 KILLARNEY DR",
            "city": "PACE",
            "state": "FL",
            "postal_code": "325718430",
            "telephone_number": "631-379-3067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6044 DOCTORS PARK",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325705072",
            "telephone_number": "850-226-6801"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13121 Atlantic Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322250102",
            "country_code": "US",
            "telephone_number": "904-221-2232",
            "fax_number": "844-273-0912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOVICH",
        "first_name": "BRIDGET",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-22",
        "last_updated": "2021-05-08",
        "certification_date": "2021-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "020808",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRIDGET",
            "last_name": "STRAUB",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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