Provider Demographics
NPI:1922851690
Name:DE JESUS BRADY, TANIA CRISTINA (NP)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:CRISTINA
Last Name:DE JESUS BRADY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 LAKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-2553
Mailing Address - Country:US
Mailing Address - Phone:863-709-4445
Mailing Address - Fax:
Practice Address - Street 1:2316 LAKEVIEW ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2553
Practice Address - Country:US
Practice Address - Phone:863-709-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024842363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care