Active NPI
Jacqueline Sergon
- Adult Health Nurse Practitioner
- Rockville, MD
National Provider Identifier
1053073254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- RN1038653
- Practice address
- 4629 Glasgow Dr
Rockville, MD 20853-3036 - Phone
- (301) 787-3555
- NPI assigned
- Oct 6, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | RN1038653 | DC | Primary |
Addresses
Primary practice location
4629 Glasgow Dr
Rockville, MD 20853-3036
Mailing address
4629 Glasgow Dr
Rockville, MD 20853-3036
Phone (301) 787-3555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN1038653 | DC | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633478400000",
"number": "1053073254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4629 GLASGOW DR",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208533036",
"telephone_number": "301-787-3555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4629 GLASGOW DR",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208533036",
"telephone_number": "301-787-3555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERGON",
"first_name": "JACQUELINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-06",
"last_updated": "2021-10-06",
"certification_date": "2021-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "DC",
"license": "RN1038653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.