Provider Demographics
NPI:1821844507
Name:BRADSELL, TYLER (RN)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BRADSELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80 BOX 15585
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0058
Mailing Address - Country:US
Mailing Address - Phone:850-610-0961
Mailing Address - Fax:
Practice Address - Street 1:PSC 80 BOX 15585
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96367-0058
Practice Address - Country:US
Practice Address - Phone:850-610-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9614070163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse