Provider Demographics
NPI:1689947038
Name:BRIGHTWATER, JOANNA AS (CNP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:AS
Last Name:BRIGHTWATER
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SAN MATEO BLVD NE STE 104
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1382
Mailing Address - Country:US
Mailing Address - Phone:505-808-2870
Mailing Address - Fax:
Practice Address - Street 1:303 SAN MATEO BLVD NE STE 104
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1382
Practice Address - Country:US
Practice Address - Phone:505-808-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP02152363LA2200X
NMRN77315363LA2200X
NMCNP-02152363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology