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General NPI Number Information
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NPI Number | 1275359374
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Entity Type | Individual
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Provider Name | LATOYA D BRADLEY
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Gender | Female
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Dates
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Enumeration Date | 11/23/2024
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 1381 SE MOHAVE CT
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-4118
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Country | US
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Telephone | 786-799-0803
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Fax |
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Provider Business Mailing Address
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Address Line | 1381 SE MOHAVE CT
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-4118
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Country | US
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Telephone | 786-799-0803
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Fax | 772-946-1447
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 13973
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License Number State | FL
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