Provider Demographics
NPI:1851500425
Name:FRADLEY, PATRICIA MCCAUGHAN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MCCAUGHAN
Last Name:FRADLEY
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 1:7300 SUNSHINE SKYWAY LN S APT 109
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4976
Mailing Address - Country:US
Mailing Address - Phone:727-906-9253
Mailing Address - Fax:
Practice Address - Street 1:7300 SUNSHINE SKYWAY LN S APT 109
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4976
Practice Address - Country:US
Practice Address - Phone:727-906-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 455492363LP0808X
FLARNP455492163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL762225200Medicaid