Jennifer Bradshaw, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL2501 Issued in FL

Practice address

100 College Blvd E
Niceville, FL 32578-1347

Phone

(850) 729-5264

NPI assigned

Aug 23, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1619643244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 MARINA COVE DR",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325784426",
            "telephone_number": "850-582-4629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COLLEGE BLVD E",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325781347",
            "telephone_number": "850-729-5264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "JENNIFER",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL2501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "bradshaj@nwfsc.edu",
            "affiliation": "N",
            "endpointDescription": "School Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "100 College Blvd E",
            "city": "Niceville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325781347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sarah Boyles, BCABA
• Brenda Mae Bozarth
• Michelle R. Brackett, COTA
• Shaunda L Bradley, O.C.
• Brittany Bradshaw
• Tempestt Dashera Bramlet
• Candace Nicole Brannon, M.S, CCLS
• Amanda L Brenci, O.D.
• Brenda K Moore DO PA
• Carmen Y. Brezna, LCSW, MSW

• All providers in Niceville, FL
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.