Provider Demographics
NPI:1073592994
Name:COHEN, BRADLEY JAMES (ARNP)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAMES
Last Name:COHEN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 TAMPA RD
Mailing Address - Street 2:STE 202
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3677
Mailing Address - Country:US
Mailing Address - Phone:727-787-5577
Mailing Address - Fax:727-781-7757
Practice Address - Street 1:3890 TAMPA RD
Practice Address - Street 2:STE 202
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3677
Practice Address - Country:US
Practice Address - Phone:727-787-5577
Practice Address - Fax:727-781-7757
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3146492363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
E8820Medicare ID - Type Unspecified
P060662Medicare UPIN