Individual
MICHELLE ANN BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
751 OAK ST STE 200, JACKSONVILLE, FL 32204-3361
(904) 634-1040
(904) 634-0109
Mailing address
3120 E BANISTER RD, ST AUGUSTINE, FL 32092-3028
(904) 982-9917
(904) 634-0109
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
5586
FL
Other
Enumeration date
10/30/2018
Last updated
04/13/2021
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