Provider Demographics
NPI:1497644397
Name:GRADY, RACHEL LAUREN (NP-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LAUREN
Last Name:GRADY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1192 CANFIELD CIR SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-1436
Mailing Address - Country:US
Mailing Address - Phone:423-790-6971
Mailing Address - Fax:
Practice Address - Street 1:1192 CANFIELD CIR SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-1436
Practice Address - Country:US
Practice Address - Phone:423-790-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040521363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner