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General NPI Number Information
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NPI Number | 1700779261
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Entity Type | Individual
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Provider Name | JASON BRADFORD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 15709 TISONS BLUFF RD
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City | JACKSONVILLE
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State | FL
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Zip | 32218-0123
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Country | US
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Telephone | 904-962-2999
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Fax |
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Provider Business Mailing Address
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Address Line | 150 BUSCH DR # 26601
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City | JACKSONVILLE
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State | FL
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Zip | 32218-5547
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Country | US
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Telephone | 904-962-2999
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Fax |
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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