MS. MARY AGNES CRADDOCK (ARNP) – Family Nurse Practitioner, NPI 1417033317
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
24,243 NURSE PRACTITIONER in FL
Provider Addresses for MS. MARY AGNES CRADDOCK (ARNP)
James A. Haley Veterans' Hospital, 13000, Bruce B Downs Boulevard, Tampa, Hillsborough County, Florida, 33612, United States
TAMPA, FL 336124745
Phone: (813) 972-2000
Type: Mailing
13000 Bruce B Downs Blvd
Tampa, FL 336124745
Phone: (813) 972-2000
Fax: (813) 903-4874
Type: Location
2 N Village Blvd Ste 2A
Sparta, NJ 078713592
Phone: (908) 441-7201
Fax: (908) 441-1292
Type: Location
PO BOX 416457
BOSTON, MA 022416457
Phone: (844) 362-1735
Fax: (973) 290-7495
Type: Mailing
653 WILLOW GROVE ST STE 2000
HACKETTSTOWN, NJ 078401789
Phone: (908) 441-7201
Fax: (908) 441-1292
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-07-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20250724000992 | I | Nurse Practitioner | NJ | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33612)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | NY | |
| - | MA | |
| Internal Medicine | MA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | PA | |
| - | NJ | |
| P S Y C H I A T R Y | NJ | |
| U R O L O G Y | NC | |
| Nurse Practitioner | NJ | |
| Internal Medicine | MA | |
| Nurse Practitioner | NJ |
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