Healthcare Provider Details

I. General information

NPI: 1154308609
Provider Name (Legal Business Name): HOLLY B BRADLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CATHERINE DR
ROCKY HILL CT
06067-1097
US

IV. Provider business mailing address

107 CATHERINE DR
ROCKY HILL CT
06067-1097
US

V. Phone/Fax

Practice location:
  • Phone: 860-841-0741
  • Fax:
Mailing address:
  • Phone: 860-841-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number001416
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: