Provider Demographics
NPI:1063618494
Name:BRADSHAW, KAREN S (ARNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10115 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3105
Mailing Address - Country:US
Mailing Address - Phone:561-328-6165
Mailing Address - Fax:561-328-6091
Practice Address - Street 1:10115 FOREST HILL BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3105
Practice Address - Country:US
Practice Address - Phone:561-328-6165
Practice Address - Fax:561-328-6091
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2739042163WW0101X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305881600Medicaid
FLQ02822Medicare UPIN
FL305881600Medicaid