Provider Demographics
NPI:1346842622
Name:BRADLEY, ARIANA (NP)
Entity Type:Individual
Prefix:
First Name:ARIANA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11207 N LAMAR BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-3056
Mailing Address - Country:US
Mailing Address - Phone:512-906-0168
Mailing Address - Fax:512-906-0158
Practice Address - Street 1:11207B N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3056
Practice Address - Country:US
Practice Address - Phone:512-906-0168
Practice Address - Fax:512-906-0158
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145439363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner