Provider Demographics
NPI:1629580519
Name:JOHNSON, BRIDGETT MICHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10380 SW VILLAGE CENTER DR STE 215
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-1931
Mailing Address - Country:US
Mailing Address - Phone:772-345-1111
Mailing Address - Fax:772-345-2222
Practice Address - Street 1:306 NW BETHANY DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986
Practice Address - Country:US
Practice Address - Phone:772-345-1111
Practice Address - Fax:772-345-2222
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9382157163W00000X
NM74494363L00000X, 363LG0600X
NY310606363LA2200X
NJ26NJ14875500363LG0600X
CA95020396363LP2300X
TX1057450363LP2300X
FL11015365363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care