MEDICARE: ROBERT N BRADY

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11012067	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F405584-01	NY

General Provider Information

NPI Number	:	1629653530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT N BRADY

Provider Business Mailing Address
First Line	:	1815 HEALTH CARE DR STE B
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-5377
Country	:	US
Telephone Number	:	727-358-9911
Fax Number	:	727-499-2612

Provider Business Practice Location Address
First Line	:	8849 HAWBUCK ST STE B
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-9805
Country	:	US
Telephone Number	:	727-358-9911
Fax Number	:	727-499-2612

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

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	12/11/2025

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