Provider Demographics
NPI:1598795007
Name:BRADSHAW, VIRGINIA (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6413
Mailing Address - Country:US
Mailing Address - Phone:815-744-8554
Mailing Address - Fax:
Practice Address - Street 1:24 WHITE BRIDGE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1411
Practice Address - Country:US
Practice Address - Phone:615-352-0011
Practice Address - Fax:615-352-0085
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007319363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3711015OtherMEDICARE PTAN
TN3046283OtherBCBS PROVIDER NUMBER
TN3043372Medicaid
TN3043372Medicaid