Provider Demographics
NPI:1417762477
Name:BRADSHAW, SAMANTHA LAUREN (RN)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LAUREN
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5729 DANBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8521
Mailing Address - Country:US
Mailing Address - Phone:850-910-2730
Mailing Address - Fax:
Practice Address - Street 1:5729 DANBURY BLVD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32571-8521
Practice Address - Country:US
Practice Address - Phone:850-910-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037635363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal