Provider Demographics
NPI:1588379887
Name:BRADFORD, ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 E JOHNSON AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6065
Mailing Address - Country:US
Mailing Address - Phone:850-494-6839
Mailing Address - Fax:833-985-3960
Practice Address - Street 1:2130 E JOHNSON AVE STE 130
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6065
Practice Address - Country:US
Practice Address - Phone:850-494-6839
Practice Address - Fax:833-985-3960
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9470087163W00000X
FL11024340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse