AMANDA MARIE BRADBURY (NPI# 1104164714) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104164714 |
| Entity Type | Individual |
| Full Name | AMANDA MARIE BRADBURY |
| Credential | PA |
| Practice Address |
21297 Olean Blvd Ste A Port Charlotte FL 33952-6704 |
| Mailing Address |
2675 Winkler Ave Fl 2 Fort Myers FL 33901-9342 |
| Practice Telephone | 8559795700 |
| Mailing Telephone | 8778563774 |
| Mailing Fax Number | 2394241421 |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2019-11-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9107038 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255723193 | Amanda Bradbury | Pharmacist | 8634 Highway 58, Harrison, TN 37341-3910 | 2015-03-02 |
| 1639406341 | Amanda L Bradbury | Case Manager/Care Coordinator | 701 W Lamm Rd, Freeport, IL 61032-9630 | 2009-11-17 |
| Street Address |
21297 OLEAN BLVD STE A |
| City | PORT CHARLOTTE |
| State | FL |
| Zip Code | 33952-6704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023012978 | Curtis E Dedrick | Internal Medicine | 21297 Olean Blvd Ste A, Port Charlotte, FL 33952-6704 | 2005-06-09 |
| 1497398606 | Bernadette Serafini | Nurse Practitioner | 21297 Olean Blvd Ste A, Port Charlotte, FL 33952-6704 | 2019-10-21 |
| 1336703974 | Meghan Nicole Jackson | Nurse Practitioner | 21297 Olean Blvd Ste A, Port Charlotte, FL 33952-6704 | 2019-04-29 |
| 1689160913 | Glodene Simone Roberts | Nurse Practitioner | 21297 Olean Blvd Ste A, Port Charlotte, FL 33952-6704 | 2018-07-10 |
| 1417457425 | Nicholas John Newbold Jr. | Nurse Practitioner | 21297 Olean Blvd Ste A, Port Charlotte, FL 33952-6704 | 2018-02-16 |
| 1245771815 | Pouria Haghighi Tajvar | Internal Medicine | 21297 Olean Blvd Ste A, Port Charlotte, FL 33952-6704 | 2017-03-16 |
| 1639520083 | Gabrielly Meurer Coatti | Internal Medicine | 21297 Olean Blvd Ste A, Port Charlotte, FL 33952-6704 | 2016-06-27 |
| 1255787370 | Monette Audath | Nurse Practitioner | 21297 Olean Blvd Ste A, Port Charlotte, FL 33952-6704 | 2016-05-07 |
| 1609230119 | Victor Manuel Pena | Family Medicine | 21297 Olean Blvd Ste A, Port Charlotte, FL 33952-6704 | 2016-04-11 |
| 1295196863 | James Ramirez | Nurse Practitioner | 21297 Olean Blvd Ste A, Port Charlotte, FL 33952-6704 | 2016-03-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700486552 | Arrow Medical LLC | Durable Medical Equipment & Medical Supplies | 3514 Tamiami Trail, Unit 104, Port Charlotte, FL 33952 | 2020-10-30 |
| 1376009621 | David Alan Mowry | Massage Therapist | 3148 Whiting Lane, Port Charlotte, FL 33952 | 2019-02-12 |
| 1124527189 | Aegis Group Practice, LLC | Physical Therapist | 2500 Aaron Street, Port Charlotte, FL 33952 | 2018-02-06 |
| 1255856118 | All Powered Mobility, LLC | Durable Medical Equipment & Medical Supplies | 2765 Tamiami Trl Ste B1, Port Charlotte, FL 33952 | 2017-08-11 |
| 1366994915 | Julianne Kumar | Physical Medicine & Rehabilitation | 4166 Tamiami Trail, Unit A, Port Charlotte, FL 33952 | 2016-10-31 |
| 1659729549 | The Gathering Place LLC | Licensed Practical Nurse | 3459 Depew Ave, Port Charlotte, FL 33952 | 2016-06-01 |
| 1003222183 | Philip Lagamma | Physical Therapist | 4161 Tamiami Trl Ste 103, Port Charlotte, FL 33952 | 2014-07-09 |
| 1184039695 | Nathan E Shipley | Driver | 2338 Alton Rd., Port Charlotte, FL 33952 | 2014-06-23 |
| 1619318219 | Nic 4 Royal Palm Leasing LLC | Assisted Living Facility | 2500 Aaron St., Port Charlotte, FL 33952 | 2013-07-11 |
| 1225306475 | Tamjo Inc | Hearing Instrument Specialist | 2811 Ste. A Tamiami Trail, Port Charlotte, FL 33952 | 2011-12-02 |
| Find all providers in zip 33952 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891267779 | Jenna Mut | Physician Assistant | 20416 Copeland Ave, Port Charlotte, FL 33952-1304 | 2018-12-17 |
| 1962752279 | Ashley Nichole Reid | Physician Assistant | 2040 Tamiami Trl, Suite C, Port Charlotte, FL 33948-2178 | 2012-09-13 |
| 1164580536 | Brian R Webster | Physician Assistant | 530 Tamiami Trail, Port Charlotte, FL 33953 | 2006-12-05 |
| 1457390270 | Mark Browning | Physician Assistant | 4161 Tamiami Trl Ste 201, Port Charlotte, FL 33952-9204 | 2006-06-06 |
| 1902859739 | Timothy Francis | Physician Assistant | 2335 Aaron St, Port Charlotte, FL 33952-5305 | 2006-05-19 |
| 1861031338 | Anisleisys Vazquez | Physician Assistant | 2852 Tamiami Trl Ste 4, Port Charlotte, FL 33952-5100 | 2020-01-02 |
| 1326500174 | Emily Jane Brown | Physician Assistant | 17928 Toledo Blade Blvd, Port Charlotte, FL 33948-1021 | 2019-04-02 |
| 1982115069 | Norah Lynn Mccrossin | Physician Assistant | 2380 Harbor Blvd, Port Charlotte, FL 33952-5024 | 2017-10-17 |
| 1467962365 | Samantha L. Jusino | Physician Assistant | 4235 Kings Highway, Suite 103, Port Charlotte, FL 33980-8421 | 2017-10-05 |
| 1821538653 | Matthew Osborne | Physician Assistant | 19531 Cochran Blvd, Port Charlotte, FL 33948-2081 | 2017-02-27 |
| Find all providers in PORT CHARLOTTE | ||||
| City | PORT CHARLOTTE |
| Zip Code | 33952 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.