Provider Demographics
NPI:1851974216
Name:BRADLEY, JASON L (HHA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 SOUTHERN PINE LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-1731
Mailing Address - Country:US
Mailing Address - Phone:941-993-0838
Mailing Address - Fax:
Practice Address - Street 1:803 SOUTHERN PINE LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-1731
Practice Address - Country:US
Practice Address - Phone:941-993-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health