Healthcare Provider Details

I. General information

NPI: 1013938810
Provider Name (Legal Business Name): PATRICIA BRAVO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 79TH STREET CSWY STE 506
NORTH BAY VILLAGE FL
33141-4178
US

IV. Provider business mailing address

1666 79TH STREET CSWY STE 506
NORTH BAY VILLAGE FL
33141-4178
US

V. Phone/Fax

Practice location:
  • Phone: 305-763-8573
  • Fax: 305-763-8574
Mailing address:
  • Phone: 305-763-8573
  • Fax: 305-763-8574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME 91464
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME91464
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: