Provider Demographics
NPI:1457169245
Name:GRAHAM, DELIA (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:DELIA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 BLUE HORIZON CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5725
Mailing Address - Country:US
Mailing Address - Phone:941-720-0715
Mailing Address - Fax:
Practice Address - Street 1:1425 BLUE HORIZON CIR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5725
Practice Address - Country:US
Practice Address - Phone:941-720-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9295708363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty