Provider Demographics
NPI:1598073454
Name:BRADFORD, LAURA A (NP-C)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5698 PIN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-1829
Mailing Address - Country:US
Mailing Address - Phone:847-989-7919
Mailing Address - Fax:
Practice Address - Street 1:3888 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1014
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:850-994-1165
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704231498363LF0000X
FLARNP9476191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily