Healthcare Provider Details

I. General information

NPI: 1912718495
Provider Name (Legal Business Name): MINU ELIZABETH BRADLEY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINU ELIZABETH JOSE, THOMAS RN

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W POLK ST UNIT B
AUBURNDALE FL
33823-3428
US

IV. Provider business mailing address

505 SEVEN OAKS ST
MULBERRY FL
33860-6533
US

V. Phone/Fax

Practice location:
  • Phone: 863-797-6544
  • Fax: 863-662-3333
Mailing address:
  • Phone: 405-590-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11037152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: