Healthcare Provider Details

I. General information

NPI: 1447762380
Provider Name (Legal Business Name): SHANE BRIDGMAN DNP, APRN, AGNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36624 GRAND ISLAND OAKS CIR
GRAND ISLAND FL
32735-9653
US

IV. Provider business mailing address

36624 GRAND ISLAND OAKS CIR
GRAND ISLAND FL
32735-9653
US

V. Phone/Fax

Practice location:
  • Phone: 352-801-9272
  • Fax: 908-274-2081
Mailing address:
  • Phone: 352-801-9272
  • Fax: 908-274-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2024045190
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number291383
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1112411
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4035372
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209028336
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0033013
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number29997
License Number StateSC
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number38021
License Number StateTN
# 9
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP032050
License Number StatePA
# 10
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9325995
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3-001918
License Number StateAL
# 12
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC-APN.0102962-C-NP
License Number StateCO
# 13
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN9325995
License Number StateFL
# 14
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10040595
License Number StateOR
# 15
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number907225
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: