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NPI Code Detail

MEDICARE: JETTA JEAN BRADY DO

MEDICARE: JETTA JEAN BRADY DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1063350049
Entity Type Code : Individual
Provider Name (Legal Business Name) : JETTA JEAN BRADY DO
Provider Business Mailing Address
First Line : 2020 59TH ST W
Second Line :
City : BRADENTON
State : FL
Zip : 34209-4604
Country : US
Telephone Number : 941-792-6611
Fax Number :
Provider Business Practice Location Address
First Line : 2020 59TH ST W
Second Line :
City : BRADENTON
State : FL
Zip : 34209-4604
Country : US
Telephone Number : 941-792-6611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ JETTA JEAN BRADY DO” Practice Location

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