Provider Demographics
NPI:1790325843
Name:FRYE, BERNADETTE ANITA (APRN)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ANITA
Last Name:FRYE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:ANITA
Other - Last Name:HUDACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4202 41ST ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-2332
Mailing Address - Country:US
Mailing Address - Phone:941-254-7670
Mailing Address - Fax:
Practice Address - Street 1:4202 41ST ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-2332
Practice Address - Country:US
Practice Address - Phone:941-254-7670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2362878363LP0808X
FLAPRN11005348363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11005348OtherSTATE LICENSE