Provider Information for 1053820050
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ANDREA BRAGDON M.S.
Sex: Female
NPI: 1053820050
Last Updated: 2024-10-15
Certification Date: 2024-10-15
Certification Date: 2024-10-15
Details
| Name | Value | ||||||||||||||||
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| NPI | 1053820050 | ||||||||||||||||
| Enumeration Date | 2017-09-22 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 555 MOULTRIE LANDING BLVD APT 6106 ST AUGUSTINE, FL 32086-5984 United States Phone: 207-844-0503 | Fax: | ||||||||||||||||
| Primary Practice Address | 4651 SALISBURY RD STE 400 JACKSONVILLE, FL 32256-6187 United States Phone: 646-941-7645 | Fax:929-596-7897 | ||||||||||||||||
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