Provider Demographics
NPI:1053121947
Name:GRADY, JONATHAN ALAN (APRN)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ALAN
Last Name:GRADY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 CYPRESS COVE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6690
Mailing Address - Country:US
Mailing Address - Phone:239-297-7377
Mailing Address - Fax:239-418-2540
Practice Address - Street 1:10200 CYPRESS COVE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-6690
Practice Address - Country:US
Practice Address - Phone:239-297-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11037320363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology