Provider Demographics
NPI:1982477261
Name:BRADLEY, TANIKA
Entity Type:Individual
Prefix:
First Name:TANIKA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W BUTLER RD STE G
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4846
Mailing Address - Country:US
Mailing Address - Phone:864-520-1131
Mailing Address - Fax:864-520-2277
Practice Address - Street 1:501 W BUTLER RD STE G
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4846
Practice Address - Country:US
Practice Address - Phone:864-520-1131
Practice Address - Fax:864-520-2277
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider