Provider Demographics
NPI:1871367573
Name:BRADSHAW, KASEY HOPE (APRN-C)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:HOPE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 LAKELAND HILLS BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2202
Mailing Address - Country:US
Mailing Address - Phone:863-333-0032
Mailing Address - Fax:
Practice Address - Street 1:3037 LAKELAND HILLS BLVD STE 7
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2202
Practice Address - Country:US
Practice Address - Phone:863-333-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily