Healthcare Provider Details

I. General information

NPI: 1457379943
Provider Name (Legal Business Name): KATHRYN L BRADLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18574 BRIGGS CIR
PT CHARLOTTE FL
33948-9600
US

IV. Provider business mailing address

18574 BRIGGS CIR
PT CHARLOTTE FL
33948-9600
US

V. Phone/Fax

Practice location:
  • Phone: 941-380-7132
  • Fax:
Mailing address:
  • Phone: 941-380-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704109509
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9255172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: