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NPI Code Detail

MEDICARE: BRIDGETT MICHELLE JOHNSON APRN

MEDICARE: BRIDGETT MICHELLE JOHNSON APRN
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
1363LP2300XPrimary Care Nurse Practitioner95020396CA
2363LP2300XPrimary Care Nurse Practitioner11015365FL
3363LG0600XGerontology Nurse Practitioner26NJ14875500NJ
4363LP2300XPrimary Care Nurse Practitioner1057450TX
5363LG0600XGerontology Nurse Practitioner74494NM
6163W00000XRegistered Nurse9382157FL
7363L00000XNurse Practitioner74494NM
8363LA2200XAdult Health Nurse Practitioner310606NY
9363LG0600XGerontology Nurse Practitioner11015365FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629580519
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIDGETT MICHELLE JOHNSON APRN
Provider Business Mailing Address
First Line : 10380 SW VILLAGE CENTER DR STE 215
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34987-1931
Country : US
Telephone Number : 929-491-7333
Fax Number : 929-491-7333
Provider Business Practice Location Address
First Line : 1481 MCDONALD AVE FL 2
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-4667
Country : US
Telephone Number : 929-491-7333
Fax Number : --
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2017
Last Update Date : 06/16/2025

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