Provider Demographics
NPI:1881874832
Name:BREDY, MARIE C (APRN-C)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:C
Last Name:BREDY
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 1:2605 ENTERPRISE RD E STE 100
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1067
Mailing Address - Country:US
Mailing Address - Phone:727-799-6255
Mailing Address - Fax:813-635-7865
Practice Address - Street 1:2605 ENTERPRISE RD E STE 100
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1067
Practice Address - Country:US
Practice Address - Phone:727-799-6255
Practice Address - Fax:813-635-7865
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12998363LF0000X
FLAPRN9495681363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506333Medicaid
FL111262200Medicaid