Provider Demographics
NPI:1407051303
Name:BRACKEN, IRIS C ANDERSON (ARNP-C)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:C ANDERSON
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:MS
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:BRACKEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:5545 MARIE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-1913
Mailing Address - Country:US
Mailing Address - Phone:813-406-1925
Mailing Address - Fax:813-782-1423
Practice Address - Street 1:5545 MARIE DR
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1913
Practice Address - Country:US
Practice Address - Phone:813-406-1925
Practice Address - Fax:813-782-1423
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2078202363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTANAJ643YMedicare UPIN