Provider Demographics
NPI:1831979970
Name:BRADLEY, DEBORAH L (CRNA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LYNN
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2840 S OCEAN BLVD APT 405
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-5555
Mailing Address - Country:US
Mailing Address - Phone:631-807-3497
Mailing Address - Fax:
Practice Address - Street 1:501 GLADES RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1419
Practice Address - Country:US
Practice Address - Phone:561-367-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025484367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered