Provider Demographics
NPI:1164672085
Name:BRAVO, ANDREA (RMT, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:BRAVO
Suffix:
Gender:F
Credentials:RMT, PHARMD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:BRAVO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9382 JENNINGS RD
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-9506
Mailing Address - Country:US
Mailing Address - Phone:561-676-8391
Mailing Address - Fax:
Practice Address - Street 1:17847 BRIAN WAY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33478-5289
Practice Address - Country:US
Practice Address - Phone:561-676-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-27
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA0021301183500000X
FLMA45592225700000X
FLPS53819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist