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NPI Code Detail

MEDICARE: TAMIA BRADLEY

MEDICARE: TAMIA BRADLEY
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1770162000
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMIA BRADLEY
Provider Business Mailing Address
First Line : 3890 DUNN AVE STE 1101
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-6432
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3890 DUNN AVE STE 1101
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-6432
Country : US
Telephone Number : 904-765-0665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2021
Last Update Date : 04/05/2021

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Directions to “ TAMIA BRADLEY ” Practice Location

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