Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 505918 | TX |
NPI | 1003863374 |
---|---|
Provider Name | Mrs. Tina Bradshaw |
First Address | Houston, TX 77046-0297 |
Second Address | Houston, TX 77030-2316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 30/03/2009 |