Basic Information
| Provider Information | |||||||||
| NPI: | 1861841132 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRATTON | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1505 DELAWARE AVE | ||||||||
| Address2: | |||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349503975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724611402 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1505 DELAWARE AVE STE 648 | ||||||||
| Address2: | |||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349503975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724611402 | ||||||||
| FaxNumber: | 8445404796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2016 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | H0087459 | MD | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | UO4896 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | OS16593 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.