Provider Demographics
NPI:1629653530
Name:BRADY, ROBERT N
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:BRADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6035
Mailing Address - Country:US
Mailing Address - Phone:727-358-9911
Mailing Address - Fax:727-499-2612
Practice Address - Street 1:1815 HEALTH CARE DR STE B
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-5377
Practice Address - Country:US
Practice Address - Phone:727-358-9911
Practice Address - Fax:727-499-2612
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012067363L00000X, 363LP0808X
NYF405584-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner