Healthcare Provider Details

I. General information

NPI: 1770834764
Provider Name (Legal Business Name): TRASSE D. BRADLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRASSE D. BROWN PA-C

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PALM AVE STE 500
JACKSONVILLE FL
32207-8457
US

IV. Provider business mailing address

PO BOX 746654
ATLANTA GA
30374-6654
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-7300
  • Fax: 904-202-2754
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9106836
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberPA9106836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: