MEDICARE: JOANNA M BRONKEMA RN, APRN, NP, CNM

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
1	163W00000X	Registered Nurse	11012794	FL
2	363LW0102X	Women's Health Nurse Practitioner	11012794	FL
3	374J00000X	Doula
4	367A00000X	Advanced Practice Midwife	11012794	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1790122174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA M BRONKEMA RN, APRN, NP, CNM

Provider Business Mailing Address
First Line	:	3621 1/2 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-2227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3621 1/2 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-2227
Country	:	US
Telephone Number	:	561-705-1022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2013
Last Update Date	:	04/16/2022

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