Provider Demographics
NPI:1013194372
Name:ANGIULLI, BRADFORD CHRISTIAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:CHRISTIAN
Last Name:ANGIULLI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE
Mailing Address - Street 2:SUITE 411
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-478-0517
Mailing Address - Fax:
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4644
Practice Address - Country:US
Practice Address - Phone:407-478-0517
Practice Address - Fax:407-646-7370
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant