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Individual
JACLYNN N BRADSHAW
Active
Individual
JACLYNN N BRADSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
17563
TN
363L00000X
Nurse Practitioner
Primary
AP60691550
WA
363LG0600X
Gerontology Nurse Practitioner
AP60691550
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17563
LICENSE
TN
05
—
2067062
—
WA
Enumeration date
04/18/2013
Last updated
03/10/2025
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