Provider Demographics
NPI:1912718495
Name:BRADLEY, MINU ELIZABETH (PMHNP)
Entity type:Individual
Prefix:
First Name:MINU
Middle Name:ELIZABETH
Last Name:BRADLEY
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:MINU
Other - Middle Name:ELIZABETH
Other - Last Name:JOSE, THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:505 SEVEN OAKS ST
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-6533
Mailing Address - Country:US
Mailing Address - Phone:405-590-2324
Mailing Address - Fax:
Practice Address - Street 1:505 SEVEN OAKS ST
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-6533
Practice Address - Country:US
Practice Address - Phone:405-590-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11037152363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health