Individual
GLENDON WAYNE BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
930 ALICIA RD, LAKELAND, FL 33801-2104
(863) 680-1950
Mailing address
930 ALICIA RD, LAKELAND, FL 33801-2104
(863) 680-1950
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11010529
FL
Other
Enumeration date
12/08/2020
Last updated
12/08/2020
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