Provider Demographics
NPI:1083793418
Name:BRADY, JOYCE ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:ANN
Last Name:BRADY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SARNO RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3989
Mailing Address - Country:US
Mailing Address - Phone:321-259-6350
Mailing Address - Fax:321-259-1605
Practice Address - Street 1:1801 SARNO RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3989
Practice Address - Country:US
Practice Address - Phone:321-259-6350
Practice Address - Fax:321-259-1605
Is Sole Proprietor?:No
Enumeration Date:2006-11-05
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3246612363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS86319Medicare UPIN
FL000E2882Medicare ID - Type UnspecifiedPROVIDER NUMBER