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NPI Code Detail

MEDICARE: BRADLEY W HILLIARD-LYTHGOE ARNP-BC

MEDICARE: BRADLEY W HILLIARD-LYTHGOE ARNP-BC
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
1363LF0000XFamily Nurse PractitionerAP60643437WA
2363LF0000XFamily Nurse PractitionerAP131265TX
3363L00000XNurse PractitionerAPRN11039752FL

General Provider Information

NPI Number : 1376984682
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY W HILLIARD-LYTHGOE ARNP-BC
Provider Business Mailing Address
First Line : 390 N COURTENAY PKWY
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32953-3456
Country : US
Telephone Number : 321-633-3162
Fax Number :
Provider Business Practice Location Address
First Line : 390 N COURTENAY PKWY
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32953-3456
Country : US
Telephone Number : 321-633-3162
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2013
Last Update Date : 04/26/2026

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