Healthcare Provider Details

I. General information

NPI: 1083017156
Provider Name (Legal Business Name): LA-SHERIA LAMARRA BRADLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LA-SHERIA GRICE

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 US HWY 27 SW
BRANFORD FL
32008-3048
US

IV. Provider business mailing address

23476 NW 186TH AVE
HIGH SPRINGS FL
32643-0673
US

V. Phone/Fax

Practice location:
  • Phone: 386-935-3090
  • Fax: 386-935-3198
Mailing address:
  • Phone: 386-454-0698
  • Fax: 386-454-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9386592
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11032082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: