Provider Demographics
NPI:1801192919
Name:BRADLEY, DAWN (ARNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12670 WHITEHALL DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3619
Mailing Address - Country:US
Mailing Address - Phone:239-936-9554
Mailing Address - Fax:239-936-8993
Practice Address - Street 1:14671 TRIPLE EAGLE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1706
Practice Address - Country:US
Practice Address - Phone:239-887-5282
Practice Address - Fax:239-443-4521
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2588722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014961300Medicaid