MEDICARE: TAYLOR BRADLEY PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	35109	TN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1166378	TX
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11031794	FL

General Provider Information

NPI Number	:	1982471173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR BRADLEY PMHNP

Provider Business Mailing Address
First Line	:	7901 4TH ST N STE 300
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-4399
Country	:	US
Telephone Number	:	662-523-3255
Fax Number	:

Provider Business Practice Location Address
First Line	:	12301 WILSHIRE BLVD STE 512
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1053
Country	:	US
Telephone Number	:	662-523-3255
Fax Number	:

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

Provider Enumeration Date	:	12/07/2023
Last Update Date	:	05/06/2026

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