Provider Demographics
NPI:1740346998
Name:BRADLEY, JACQUELINE JONES (CNP)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:JONES
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4900 MASSACHUSETTS AVE NW
Mailing Address - Street 2:STE 250
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4316
Mailing Address - Country:US
Mailing Address - Phone:202-629-3536
Mailing Address - Fax:202-379-1485
Practice Address - Street 1:2101 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4908
Practice Address - Country:US
Practice Address - Phone:301-816-2424
Practice Address - Fax:301-388-1740
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR089410363LP2300X
DCRN51705363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP29337Medicare UPIN
007700M92Medicare ID - Type Unspecified