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General NPI Number Information
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NPI Number | 1447762380
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Entity Type | Individual
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Provider Name | SHANE BRIDGMAN DNP, APRN, AGNP-BC
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Gender | Male
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 880 SW 145TH AVE STE 202
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-6171
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Country | US
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Telephone | 866-849-0692
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 211699
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City | EAGAN
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State | MN
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Zip | 55121-3699
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Country | US
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Telephone | 866-849-0692
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Fax | 888-973-8821
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP61647468
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4035372
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209028336
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 291383
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 38021
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1112411
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3-001918
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License Number State | AL
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0033013
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License Number State | OH
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Taxonomy #9
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP032050
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License Number State | PA
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Taxonomy #10
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 10040595
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License Number State | OR
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Taxonomy #11
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9325995
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License Number State | FL
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Taxonomy #12
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2024045190
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License Number State | MO
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Taxonomy #13
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | C-APN.0102962-C-NP
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License Number State | CO
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Taxonomy #14
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 29997
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License Number State | SC
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Taxonomy #15
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 907225
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License Number State | MS
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