Healthcare Provider Details

I. General information

NPI: 1063618494
Provider Name (Legal Business Name): KAREN S. BRADSHAW NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 LAKE WORTH RD #100W
GREENACRES FL
33467
US

IV. Provider business mailing address

10115 FOREST HILL BLVD SUITE 300
WELLINGTON FL
33414-3105
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-9559
  • Fax: 561-964-9904
Mailing address:
  • Phone: 561-328-6165
  • Fax: 561-328-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number2739042
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2739042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: