Individual
BRADLEY DANIEL JACKSON
Active
Individual
BRADLEY DANIEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9312860
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003243800
—
FL
05
—
126061
—
AL
01
—
592-13562
BLUE CROSS BLUE SHIELD
AL
01
—
G00ME
BLUE CROSS BLUE SHIELD
FL
01
—
P00959140
MEDICARE RAILROAD
—
Enumeration date
02/10/2011
Last updated
08/25/2020
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