MEDICARE: TAMMY LYNN BRADFORD CPNP

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	363LP0200X	Pediatric Nurse Practitioner	604545	TX
2	363LP0200X	Pediatric Nurse Practitioner	AP124085	TX

General Provider Information

NPI Number	:	1801237771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY LYNN BRADFORD CPNP

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 UNIVERSITY BLVD
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1053
Country	:	US
Telephone Number	:	512-509-0200
Fax Number	:

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

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	06/23/2026

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