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NPI Code Detail

MEDICARE: MS. LETICIA BRAVO ARNP

MEDICARE: MS. LETICIA BRAVO ARNP
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
1363LF0000XFamily Nurse Practitioner9197551FL

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 : 1427451327
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LETICIA BRAVO ARNP
Provider Business Mailing Address
First Line : 1302 RIVER ST
Second Line :
City : PALATKA
State : FL
Zip : 32177-5042
Country : US
Telephone Number : 386-328-0108
Fax Number : 386-325-1086
Provider Business Practice Location Address
First Line : 306 UNION AVE
Second Line :
City : CRESCENT CITY
State : FL
Zip : 32112-4432
Country : US
Telephone Number : 386-698-1232
Fax Number : 386-698-4154
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2014
Last Update Date : 03/11/2020

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