Provider Demographics
NPI:1750851044
Name:BRADLEY, DARMETA RASHANE (APRN)
Entity Type:Individual
Prefix:
First Name:DARMETA
Middle Name:RASHANE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 BEACON BAY CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-8190
Mailing Address - Country:US
Mailing Address - Phone:407-446-5004
Mailing Address - Fax:
Practice Address - Street 1:1949 BEACON BAY CT
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-8190
Practice Address - Country:US
Practice Address - Phone:407-446-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000321364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health