Provider Demographics
NPI:1083729990
Name:BRADFORD, CAROL S (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:S
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:NP-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10097
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85130-0020
Mailing Address - Country:US
Mailing Address - Phone:520-836-3446
Mailing Address - Fax:520-836-8807
Practice Address - Street 1:36305 N GANTZEL RD STE 102
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85140-7326
Practice Address - Country:US
Practice Address - Phone:800-233-3264
Practice Address - Fax:480-987-6905
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZAP2458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ72277Medicare UPIN