Provider Demographics
NPI:1790122174
Name:BRONKEMA, JOANNA M (RN, APRN, NP, CNM)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:BRONKEMA
Suffix:
Gender:F
Credentials:RN, APRN, NP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 1/2 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-2227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3621 1/2 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-2227
Practice Address - Country:US
Practice Address - Phone:561-705-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-26
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012794163W00000X, 363LW0102X, 367A00000X, 367A00000X
374J00000X, 374J00000X
CA235827367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA885772Medicaid