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General NPI Number Information
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NPI Number | 1790441871
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Entity Type | Individual
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Provider Name | ALLEN BRACEBRIDGE APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 515 E WASHINGTON BLVD
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City | CRESCENT CITY
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State | CA
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Zip | 95531-8342
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Country | US
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Telephone | 707-460-1802
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Fax |
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Provider Business Mailing Address
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Address Line | 501 N ORLANDO AVE STE 313 #163
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City | WINTER PARK
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State | FL
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Zip | 32789-7310
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11015363
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License Number State | FL
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