Individual
MR. BRADLEY JAMES WINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8202
(904) 202-2000
Mailing address
1010 N 102ND ST STE 300, OMAHA, NE 68114-2122
(904) 202-2000
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
RN9524431
FL
Other
Enumeration date
11/19/2019
Last updated
11/19/2019
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