Healthcare Provider Details

I. General information

NPI: 1932628484
Provider Name (Legal Business Name): JASON E BRADLEY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 QUINN DR STE 160
PITTSBURGH PA
15275-1055
US

IV. Provider business mailing address

200 QUINN DR STE 160
PITTSBURGH PA
15275-1055
US

V. Phone/Fax

Practice location:
  • Phone: 412-722-1003
  • Fax: 412-722-1024
Mailing address:
  • Phone: 412-722-1003
  • Fax: 412-722-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11013995
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017959
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: