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General NPI Number Information
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NPI Number | 1932628484
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Entity Type | Individual
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Provider Name | JASON E BRADLEY NP
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Gender | Male
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 100 GORWOOD DR
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City | CORAOPOLIS
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State | PA
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Zip | 15108-9374
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Country | US
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Telephone | 412-336-8550
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Fax |
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Provider Business Mailing Address
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Address Line | 12161 MERCADO DR # 123
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City | VENICE
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State | FL
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Zip | 34293-1147
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Country | US
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Telephone | 941-292-0123
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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 | APRN11013995
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP017959
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License Number State | PA
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