MR. BRENT S MICKLEY (NPI# 1124034269) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124034269 |
| Entity Type | Individual |
| Full Name | MR. BRENT S MICKLEY |
| Credential | PA |
| Practice Address |
14534 Old Saint Augustine Rd Ste 3420 Jacksonville FL 32258-2616 |
| Mailing Address |
Po Box 43667 Jacksonville FL 32203-3667 |
| Practice Telephone | 9044938001 |
| Practice Fax Number | 9043380852 |
| Mailing Telephone | 9047200599 |
| Mailing Fax Number | 9043764036 |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-03-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9103362 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 0010-05496 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 018231000 | 05 | |
| FL | RR MEDICARE | P01718560 | 01 |
| Street Address |
14534 OLD SAINT AUGUSTINE RD STE 3420 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32258-2616 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437150349 | Praveen Kanaparti | Internal Medicine | 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 | 2005-08-02 |
| 1588214845 | Katrina Romanow | Nurse Practitioner | 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 | 2019-09-18 |
| 1184055246 | Erica Brasfield | Nurse Practitioner | 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 | 2013-11-27 |
| 1831462829 | Baptist Cardiology, Inc. | Internal Medicine | 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 | 2012-02-22 |
| 1356654339 | Emiliana Franco Ladron De Guevara | Internal Medicine | 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 | 2010-07-20 |
| 1962653212 | Judith G Rewis | Nurse Practitioner | 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 | 2008-10-06 |
| 1699960450 | Michele Foeks | Physician Assistant | 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 | 2007-09-13 |
| 1851318828 | Bonnie Jean Gandee | Physician Assistant | 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 | 2006-07-16 |
| 1033141692 | Bharat Kumar Gummadi | Internal Medicine | 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 | 2006-07-06 |
| 1215995386 | Edward Wesley Bisher | Internal Medicine | 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 | 2006-05-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437794237 | Nicoleta Descalzo | Behavior Technician | 12724 Grand Bay Parkway West, Suite 410, Jacksonville, FL 32258 | 2019-11-15 |
| 1992275572 | William Lundgren | Nurse Anesthetist, Certified Registered | 3625 University Blvd South, Jacksonville, FL 32258 | 2018-11-27 |
| 1104301159 | Emergency Physicians Inc | Emergency Medicine | 14534 Old St Augustine Rd, Suite 3110, Jacksonville, FL 32258 | 2018-09-26 |
| 1679092886 | Palm Life Medical Associates Pa | Assisted Living Facility | 12494 Acosta Oaks Drive, Jacksonville, FL 32258 | 2017-09-19 |
| 1679013932 | Optometry Vision Care Pllc | Optometrist | 14866 Old St. Augustine Rd Unit 110, Jacksonville, FL 32258 | 2017-03-06 |
| 1467991950 | North Florida Vision Group Inc | Optometrist | 14866 Old St. Augustine Rd., Suite 110, Jacksonville, FL 32258 | 2017-02-16 |
| 1124576566 | Revolution Chiropractic LLC | Chiropractor | 14866 Old St Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-14 |
| 1396291936 | Robyn Reaves | Nurse Practitioner | 12361 Richards Glen Ct, Jacksonville, FL 32258 | 2016-09-01 |
| 1326595927 | Lauren Cost | Chiropractor | 14866 Old St. Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-01 |
| 1487991170 | Mark Steven Colosimo | Pharmacist | 13820 Old St Augustine Road, Jacksonville, FL 32258 | 2013-01-15 |
| Find all providers in zip 32258 | ||||
| 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 |
|---|---|---|---|---|
| 1831799527 | Emily Vander Zee | Physician Assistant | 6680 Bennett Creek Dr Apt 213, Jacksonville, FL 32216-0018 | 2020-10-30 |
| 1245830314 | Jonathan V Korah | Physician Assistant | 6650 Corporate Center Pkwy Apt 1108, Jacksonville, FL 32216-8725 | 2020-10-28 |
| 1255931473 | Rachel Gavrielle Stahly | Physician Assistant | 11438 Emuness Rd, Jacksonville, FL 32218-4050 | 2020-10-27 |
| 1760099071 | Laura Alexandra Ramos-heckman | Physician Assistant | 2014 Capistrano Dr, Jacksonville, FL 32224-3091 | 2020-09-30 |
| 1184230583 | Julian Clouse | Physician Assistant | 9803 Creekfront Rd Apt 307, Jacksonville, FL 32256-8449 | 2020-09-21 |
| 1962016717 | Stephanie Benton Gentry | Physician Assistant | 3179 Shadow Creek Rd, Jacksonville, FL 32226-2386 | 2020-08-31 |
| 1629689435 | Monarch Mental Health Association | Physician Assistant | 5393 Roosevelt Blvd Ste 8, Jacksonville, FL 32210-8424 | 2020-08-14 |
| 1235749425 | Nicole Lhommedieu | Physician Assistant | 3850 Marnie Pl, Jacksonville, FL 32223-3541 | 2020-08-03 |
| 1861002123 | Naw-am Acio Daniels | Physician Assistant | 7467 Volley Dr N, Jacksonville, FL 32277-9368 | 2020-08-03 |
| 1750906640 | Veronica Adriana Dediego | Physician Assistant | 915 W Monroe St Ste 300, Jacksonville, FL 32204-1177 | 2020-06-16 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32258 |
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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.