Provider Demographics
NPI:1700267507
Name:ELLIOTT, BRADLEY (CRNP)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:CRNP
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 1765
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-1765
Mailing Address - Country:US
Mailing Address - Phone:256-831-8807
Mailing Address - Fax:
Practice Address - Street 1:731 LEIGHTON AVE STE 300
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5762
Practice Address - Country:US
Practice Address - Phone:256-236-4121
Practice Address - Fax:256-237-5254
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136329363LF0000X
AL841-13229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily