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NPI Code Detail

MEDICARE: SHANE BRIDGMAN DNP, APRN, AGNP-BC

MEDICARE: SHANE BRIDGMAN DNP, APRN, AGNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner2024045190MO
2363L00000XNurse Practitioner291383AZ
3363L00000XNurse Practitioner1112411TX
4363L00000XNurse Practitioner4035372KY
5363L00000XNurse Practitioner209028336IL
6363L00000XNurse Practitioner0033013OH
7363L00000XNurse Practitioner29997SC
8363L00000XNurse Practitioner38021TN
9363L00000XNurse PractitionerSP032050PA
10363LA2200XAdult Health Nurse PractitionerAPRN9325995FL
11363L00000XNurse Practitioner3-001918AL
12363L00000XNurse PractitionerC-APN.0102962-C-NPCO
13363LG0600XGerontology Nurse PractitionerAPRN9325995FL
14363L00000XNurse Practitioner10040595OR
15363L00000XNurse Practitioner907225MS

General Provider Information

NPI Number : 1447762380
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANE BRIDGMAN DNP, APRN, AGNP-BC
Provider Business Mailing Address
First Line : 36624 GRAND ISLAND OAKS CIR
Second Line :
City : GRAND ISLAND
State : FL
Zip : 32735-9653
Country : US
Telephone Number : 352-801-9272
Fax Number : 908-274-2081
Provider Business Practice Location Address
First Line : 36624 GRAND ISLAND OAKS CIR
Second Line :
City : GRAND ISLAND
State : FL
Zip : 32735-9653
Country : US
Telephone Number : 352-801-9272
Fax Number : 908-274-2081
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2017
Last Update Date : 12/15/2025

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