MEDICARE: DELIA GRAHAM ACNPC-AG

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
1	363LA2100X	Acute Care Nurse Practitioner	9295708	FL

General Provider Information

NPI Number	:	1457169245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELIA GRAHAM ACNPC-AG

Provider Business Mailing Address
First Line	:	1425 BLUE HORIZON CIR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-5725
Country	:	US
Telephone Number	:	941-720-0715
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 BLUE HORIZON CIR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-5725
Country	:	US
Telephone Number	:	941-720-0715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2024
Last Update Date	:	12/25/2024

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