Provider Demographics
NPI:1528633161
Name:BHARADWAJ, NEETI (FNP-C)
Entity type:Individual
Prefix:
First Name:NEETI
Middle Name:
Last Name:BHARADWAJ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:PRAGATI
Other - Middle Name:
Other - Last Name:BHARADWAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3416 SENECA CLUB LOOP UNIT C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-3134
Mailing Address - Country:US
Mailing Address - Phone:407-403-0105
Mailing Address - Fax:
Practice Address - Street 1:3416 SENECA CLUB LOOP UNIT C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-3134
Practice Address - Country:US
Practice Address - Phone:407-403-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013214363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner