MEDICARE: APRIL CHRISTINA BRADER DOM

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
1	171100000X	Acupuncturist	4092	FL

General Provider Information

NPI Number	:	1174127070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL CHRISTINA BRADER DOM

Provider Business Mailing Address
First Line	:	193 MAR ST
Second Line	:
City	:	ST PETE BEACH
State	:	FL
Zip	:	33706-2808
Country	:	US
Telephone Number	:	727-515-8380
Fax Number	:

Provider Business Practice Location Address
First Line	:	193 MAR ST
Second Line	:
City	:	ST PETE BEACH
State	:	FL
Zip	:	33706-2808
Country	:	US
Telephone Number	:	727-515-8380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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