Healthcare Provider Details

I. General information

NPI: 1376984682
Provider Name (Legal Business Name): BRADLEY W HILLIARD-LYTHGOE ARNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N COURTENAY PKWY
MERRITT ISLAND FL
32953-3456
US

IV. Provider business mailing address

390 N COURTENAY PKWY
MERRITT ISLAND FL
32953-3456
US

V. Phone/Fax

Practice location:
  • Phone: 321-633-3162
  • Fax:
Mailing address:
  • Phone: 321-633-3162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60643437
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131265
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11039752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: