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General NPI Number Information
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NPI Number | 1801773965
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Entity Type | Organization
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Legal Business Name | BREATHING CLINIC
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 36624 GRAND ISLAND OAKS CIR
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City | GRAND ISLAND
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State | FL
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Zip | 32735-9653
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Country | US
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Telephone | 352-551-3013
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Fax |
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Provider Business Mailing Address
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Address Line | 36624 GRAND ISLAND OAKS CIR
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City | GRAND ISLAND
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State | FL
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Zip | 32735-9653
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Country | US
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Telephone | 352-551-3013
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHANE BRIDGMAN
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Credential | DNP
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Telephone | 352-801-9272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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