Provider Demographics
NPI:1861001745
Name:MCCREE BRADDY, JESSICA MICHELLE (CNA/CCMA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHELLE
Last Name:MCCREE BRADDY
Suffix:
Gender:F
Credentials:CNA/CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-5418
Mailing Address - Country:US
Mailing Address - Phone:904-577-2440
Mailing Address - Fax:
Practice Address - Street 1:5630 BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5418
Practice Address - Country:US
Practice Address - Phone:904-577-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030001488376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide