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Individual
PHUONG DIEP BRADFORD
Active
Individual
PHUONG DIEP BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
APRN11007879
FL
363LF0000X
Family Nurse Practitioner
Primary
APRN11007879
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111161400
—
FL
01
—
RJJ5H
BLUE CROSS BLUE SHIELD
FL
Enumeration date
10/21/2020
Last updated
03/15/2022
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