Provider Demographics
NPI:1073801650
Name:BRADLEY, VALERIE ANN (FNP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:ANN
Other - Last Name:WEIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2990 N CAMPBELL AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2995
Mailing Address - Country:US
Mailing Address - Phone:520-777-7725
Mailing Address - Fax:
Practice Address - Street 1:2990 N CAMPBELL AVE STE 230
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2995
Practice Address - Country:US
Practice Address - Phone:520-615-3996
Practice Address - Fax:520-615-3998
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ85747363LA2200X
AZTAP4148363LF0000X
AZAP4148363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ854428Medicaid