Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2739042 | FL |
NPI | 1063618494 |
---|---|
Provider Name | Karen S Bradshaw |
First Address | Wellington, FL 33414-3105 |
Second Address | Wellington, FL 33414-3105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 02/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
305881600 | (05) | FL |
Q02822 | (02) | FL |