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NPI Code Detail

MEDICARE: BRADLEY RICHARDSON CRNA

MEDICARE: BRADLEY RICHARDSON CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse168679TN
2367500000XCertified Registered Nurse Anesthetist13924TN
3367500000XCertified Registered Nurse Anesthetist55704NM
4367500000XCertified Registered Nurse Anesthetist11004008FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336110865
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY RICHARDSON CRNA
Provider Business Mailing Address
First Line : 4602 CR 673 # 7577
Second Line :
City : BUSHNELL
State : FL
Zip : 33513-8358
Country : US
Telephone Number : 719-231-1238
Fax Number :
Provider Business Practice Location Address
First Line : 300 PINELLAS ST
Second Line :
City : CLEARWATER
State : FL
Zip : 33756-3892
Country : US
Telephone Number : 727-543-4850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 04/29/2022

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