Healthcare Provider Details

I. General information

NPI: 1497008643
Provider Name (Legal Business Name): JANET M BRADSTREET ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANET M BRADSTREET-COOPE ARNP

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 HOLSONBACK DR
DAYTONA BEACH FL
32117-5114
US

IV. Provider business mailing address

1845 HOLSONBACK DR
DAYTONA BEACH FL
32117-5114
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-0500
  • Fax: 386-274-0860
Mailing address:
  • Phone: 386-274-0500
  • Fax: 386-274-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberARNP 9273875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: