MEDICARE: DAVID BRADSHAW

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	363LA2100X	Acute Care Nurse Practitioner	11034343	FL

General Provider Information

NPI Number	:	1225867070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BRADSHAW

Provider Business Mailing Address
First Line	:	2782 LANTANA LAKES DR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-4621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15496 MAX LEGGETT PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-2564
Country	:	US
Telephone Number	:	904-895-5400
Fax Number	:	904-895-5401

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

Provider Enumeration Date	:	07/30/2024
Last Update Date	:	01/16/2025

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Directions to “ DAVID BRADSHAW ” Practice Location

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