Provider Demographics
NPI:1083942379
Name:BRADDOCK, STEPHANIE D (APN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:BRADDOCK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 HARDING RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205
Mailing Address - Country:US
Mailing Address - Phone:615-269-4545
Mailing Address - Fax:
Practice Address - Street 1:4230 HARDING RD
Practice Address - Street 2:SUITE 435
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-301-6415
Practice Address - Fax:713-344-9420
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN14455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily