Provider Demographics
NPI:1962482224
Name:BRADLEY, JONNA ARNO (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JONNA
Middle Name:ARNO
Last Name:BRADLEY
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:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324-0676
Mailing Address - Country:US
Mailing Address - Phone:850-593-5037
Mailing Address - Fax:
Practice Address - Street 1:278 LASALLE LEFALL DR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-5324
Practice Address - Country:US
Practice Address - Phone:850-875-7500
Practice Address - Fax:850-875-3618
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1896452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0346268-00Medicaid
FLE6106ZMedicare ID - Type Unspecified
FL0346268-00Medicaid