Provider Demographics
NPI:1477625457
Name:BRADY, EVELYN KNOBLOCK (ARNP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:KNOBLOCK
Last Name:BRADY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 BIGGERS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3102
Mailing Address - Country:US
Mailing Address - Phone:904-726-0174
Mailing Address - Fax:
Practice Address - Street 1:4311 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6123
Practice Address - Country:US
Practice Address - Phone:904-855-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP546142363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology