Provider Demographics
NPI:1336713973
Name:BRADLEY, ADRIENNE LAINE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:LAINE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 BROKEN SOUND PKWY NW APT 402
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3666
Mailing Address - Country:US
Mailing Address - Phone:740-704-4213
Mailing Address - Fax:
Practice Address - Street 1:6859 SW 18TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7015
Practice Address - Country:US
Practice Address - Phone:561-368-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013236367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife