MEDICARE: JESSICA O'GRADNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	APRN9203036	FL
2	363LP2300X	Primary Care Nurse Practitioner	R207964	MD

General Provider Information

NPI Number	:	1497133490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA O'GRADNEY

Provider Business Mailing Address
First Line	:	6610 RIDGECREST PL
Second Line	:
City	:	NEW MARKET
State	:	MD
Zip	:	21774-7600
Country	:	US
Telephone Number	:	813-957-7399
Fax Number	:

Provider Business Practice Location Address
First Line	:	6610 RIDGECREST PL
Second Line	:
City	:	NEW MARKET
State	:	MD
Zip	:	21774-7600
Country	:	US
Telephone Number	:	813-957-7399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	05/08/2026

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