Healthcare Provider Details

I. General information

NPI: 1629653530
Provider Name (Legal Business Name): ROBERT N BRADY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8849 HAWBUCK ST STE B
TRINITY FL
34655-9805
US

IV. Provider business mailing address

1815 HEALTH CARE DR STE B
TRINITY FL
34655-5377
US

V. Phone/Fax

Practice location:
  • Phone: 727-358-9911
  • Fax: 727-499-2612
Mailing address:
  • Phone: 727-358-9911
  • Fax: 727-499-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11012067
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF405584-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: