JARED A DESTACKELBERG (NPI# 1104136399) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104136399 |
| Entity Type | Individual |
| Full Name | JARED A DESTACKELBERG |
| Credential | PA |
| Practice Address |
1901 Se 18th Ave Ste 101 Ocala FL 34471-8215 |
| Practice Telephone | 3526223360 |
| Practice Fax Number | 3526713269 |
| Mailing Telephone | 3526223360 |
| Mailing Fax Number | 3526713269 |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2010-10-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PAT 9105672 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1901 SE 18TH AVE STE 101 |
| City | OCALA |
| State | FL |
| Zip Code | 34471-8215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205834728 | Edward D King | Urology | 1901 Se 18th Ave, Bldg 300, Ocala, FL 34471-8215 | 2005-07-08 |
| 1518515634 | David Otis Hogan | Nurse Practitioner | 1901 Se 18th Ave, Ocala, FL 34471-8215 | 2019-09-02 |
| 1770942492 | Tracy Schrader | Registered Nurse | 1901 Se 18th Ave, Suite 101, Ocala, FL 34471-8215 | 2016-02-23 |
| 1841658812 | Ashley Evonne Morris | Registered Nurse | 1901 Se 18th Ave, Suite 101, Ocala, FL 34471-8215 | 2016-02-05 |
| 1538544531 | Debbi Renee Croley | Nurse Practitioner | 1901 Se 18th Ave, Suite 400, Ocala, FL 34471-8215 | 2015-07-21 |
| 1720363138 | Matthew Keith Yelken | Physician Assistant | 1901 Se 18th Ave, #400, Ocala, FL 34471-8215 | 2011-10-17 |
| 1780907519 | Alpha Rehab & Spine Strengthening LLC | Physical Therapist | 1901 Se 18th Ave, Suite 102, Ocala, FL 34471 | 2010-03-08 |
| 1649418609 | Advanced Urology Institute, LLC | Durable Medical Equipment & Medical Supplies | 1901 Se 18th Ave, Bldg 300, Ocala, FL 34471-8214 | 2009-01-29 |
| 1417146457 | Marsha Corbin Mcdaniel | Physical Therapist | 1901 Se 18th Ave, Building 500, Ocala, FL 34471-8215 | 2007-10-16 |
| 1912196957 | Lisa Ann Joranlien | Physical Therapist | 1901 Se 18th Ave, Building 500, Ocala, FL 34471-8215 | 2007-10-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790385383 | Samer Faragalla | Pharmacist | 2600 Sw 19th Ave Rd, Ocala, FL 34471 | 2020-10-31 |
| 1336789684 | Anthony Smith | Behavior Technician | 2102 Sw 20th Place Ste 302, Ocala, FL 34471 | 2020-01-14 |
| 1871136788 | Toni Trask | Counselor | 300 Se Sanchez Ave, Ocala, FL 34471 | 2019-10-23 |
| 1538701354 | Sdx Home Care Operations, LLC | In Home Supportive Care | 1315 Se 25th Loop #102, Ocala, FL 34471 | 2019-10-14 |
| 1730666355 | Next Pt Group Florida, LLC | Occupational Therapist | 1661 Se 31st St Unit 3, Ocala, FL 34471 | 2018-07-26 |
| 1902397680 | Aidan Thurian Charles | Student in an Organized Health Care Education/Training Program | 1431 Sw First Avenue, Ocalu, FL 34471 | 2018-05-29 |
| 1871084426 | Infectious Diseases Specialty Associates Pllc | Internal Medicine | 150 Se 17th St Ste 801, Ocala, FL 34471 | 2018-05-18 |
| 1528560950 | Guillot Enterprises, LLC | Hearing Instrument Specialist | 2400 Sw College Rd., Suite 202, Ocala, FL 34471 | 2018-03-01 |
| 1518469071 | Jordan Griffis | Nurse Practitioner | 1630 Se 18th Street Building 600 Suite 602, Ocala, FL 34471 | 2018-03-01 |
| 1780192112 | Pmc Knee Pain & Restoration LLC | Preventive Medicine | 200 Sw 8th St Ste A, Ocala, FL 34471 | 2018-01-19 |
| Find all providers in zip 34471 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477178747 | Nykia-george Anthea Bryan | Physician Assistant | 1710 Nw 19th St, Ocala, FL 34475-4989 | 2020-06-12 |
| 1013552439 | Mikayla Bogulski | Physician Assistant | 10455 Sw 73rd Ave, Ocala, FL 34476-9119 | 2019-11-08 |
| 1811546013 | Tabitha Kicklighter | Physician Assistant | 2221 Sw 19th Avenue Rd Unit 100, Ocala, FL 34471-7758 | 2019-09-10 |
| 1578128252 | Jonathan Kletter | Physician Assistant | 4031 Se 20th St, Ocala, FL 34471-5676 | 2019-05-07 |
| 1104395144 | Colby Joel Barker | Physician Assistant | 3451 Se 107th Pl, Ocala, FL 34480 | 2018-11-20 |
| 1649725326 | Colby Beck | Physician Assistant | 3210 Sw 33rd Rd Ste 101, Ocala, FL 34474 | 2016-08-23 |
| 1831560085 | Amy Balius | Physician Assistant | 8399 Sw 80th St, Suite 15, Ocala, FL 34481-9120 | 2015-10-14 |
| 1851774731 | Ashley Love | Physician Assistant | 4600 Sw 46th Ct Ste 150, Ocala, FL 34474-5753 | 2015-07-09 |
| 1811381627 | Jessica O'carroll | Physician Assistant | 1901 Se 18th Ave Ste 400, Ocala, FL 34471 | 2015-03-19 |
| 1407297773 | Lina Marcela Chapman | Physician Assistant | 2300 Se 17th St Ste 500, Ocala, FL 34471-9139 | 2013-07-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.