Provider Demographics
NPI:1417256033
Name:ERIKA BRADSHAW, P.A.
Entity Type:Organization
Organization Name:ERIKA BRADSHAW, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-810-1688
Mailing Address - Street 1:PO BOX 3206
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-3206
Mailing Address - Country:US
Mailing Address - Phone:813-810-1688
Mailing Address - Fax:813-654-3377
Practice Address - Street 1:311 NOLAND DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5727
Practice Address - Country:US
Practice Address - Phone:813-810-1688
Practice Address - Fax:813-654-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME83385OtherLICENSE NUMBER
H79486Medicare UPIN
FLME83385OtherLICENSE NUMBER
U0300AMedicare PIN