Ryan Bradley, PA-C, CAQ-PSY
Individual provider Active NPI Medical Physician Assistant · Eglin, FL
NPI 1235862012 · NPPES record last updated Oct 4, 2024
Key facts
- NPI
- 1235862012
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 9118992 (FL)
- Practice address
- 4315 El Salvador Way
Eglin, FL 32542-1711 - Phone
- (575) 386-6585
- NPI assigned
- Jul 7, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1198847 | TX | MD | Physician Assistant |
| 9118992 | FL | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dragonfly Behavioral Health Services LLC | Current |
Accepting new patients |
Locations
1 11th Ave
Ste A2
Shalimar, FL 32579
Phone (850) 468-2493
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 9118992 | FL | Yes |
| Physician Assistant | 363A00000X | 1198847 | TX |
Addresses
Primary practice location
4315 El Salvador Way
Eglin, FL 32542-1711
Mailing address
6600 Van Aalst Blvd
Fort Moore, GA 31905-2102
Phone (915) 742-2273
Other practice location 1
6600 Van Aalst Blvd
Fort Moore, GA 31905-2102
Phone (915) 742-2273
Other practice location 2
1 11th Ave Ste A2
Shalimar, FL 32579-1318
Phone (850) 790-9621
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B224-972-93-800-0 | Other | FL | STATE DRIVERS LICENSE |
Other providers in Eglin, FL
- Victoria Margaret Baker-Janis
- Amanda Bell
- Biloxi Vamc
- Heather Dawn Brock
- Wesley Cole
- Deana Joy Dogherra
- Joel Evan Elliott
- Christopher James Gardner
All providers in Eglin, FL · Medical Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.