Provider Demographics
NPI:1730793290
Name:BRADFORD, VIRDIA CHRISTINA (CLPN)
Entity type:Individual
Prefix:
First Name:VIRDIA
Middle Name:CHRISTINA
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:CLPN
Other - Prefix:
Other - First Name:VIRDIA
Other - Middle Name:CHRISTINA
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4336 BURTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-8016
Mailing Address - Country:US
Mailing Address - Phone:662-435-1324
Mailing Address - Fax:
Practice Address - Street 1:8100 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6093
Practice Address - Country:US
Practice Address - Phone:850-477-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS319147164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse