Provider Demographics
NPI:1306279443
Name:BRADSHAW, OPAL
Entity type:Individual
Prefix:
First Name:OPAL
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OPAL
Other - Middle Name:
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:9360 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3112
Mailing Address - Country:US
Mailing Address - Phone:754-581-2836
Mailing Address - Fax:
Practice Address - Street 1:1200 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5413
Practice Address - Country:US
Practice Address - Phone:954-981-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9214224163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse