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General NPI Number Information
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NPI Number | 1780999052
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Entity Type | Individual
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Provider Name | JAROSLAW GRADEK APRN
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Gender | Male
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 1601 SW ARCHER RD
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City | GAINESVILLE
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State | FL
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Zip | 32608-1135
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Country | US
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Telephone | 352-376-1611
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Fax |
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Provider Business Mailing Address
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Address Line | 7492 NE 28TH AVE
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City | OCALA
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State | FL
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Zip | 34479-8411
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Country | US
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Telephone | 352-258-6243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN67990
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN9400023
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License Number State | FL
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