Healthcare Provider Details

I. General information

NPI: 1902921273
Provider Name (Legal Business Name): PATRICIA ANNE BRADFORD F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 MESA RD.
BOLINAS CA
94924-1038
US

IV. Provider business mailing address

PO BOX 910
POINT REYES STATION CA
94956-0910
US

V. Phone/Fax

Practice location:
  • Phone: 415-868-0124
  • Fax: 415-868-2152
Mailing address:
  • Phone: 415-663-8781
  • Fax: 415-663-9632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number194583NPCERT3684
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN194583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: