Basic Information
| Provider Information | |||||||||
| NPI: | 1932628484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADLEY | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25086 OLYMPIA AVE UNIT 320 | ||||||||
| Address2: | |||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9415055500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2652 DARLINGTON RD STE 10 | ||||||||
| Address2: | |||||||||
| City: | BEAVER FALLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150101295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248913278 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2017 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN692604 | PA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | SP017959 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.