Provider Demographics
NPI:1932628484
Name:BRADLEY, JASON E (APRN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:E
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12161 MERCADO DR # 123
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1147
Mailing Address - Country:US
Mailing Address - Phone:941-292-0123
Mailing Address - Fax:
Practice Address - Street 1:605 SHARON RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-1919
Practice Address - Country:US
Practice Address - Phone:724-773-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017959363LF0000X
FLAPRN11013995363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily