MARK F JACKSON (NPI# 1255470209) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255470209 |
| Entity Type | Individual |
| Full Name | MARK F JACKSON |
| Credential | M.D. |
| Practice Address |
3930 Us 1 S Saint Augustine FL 32086-7089 |
| Mailing Address |
4881 Nw 8th Ave Suite 2 Gainesville FL 32605-4582 |
| Practice Telephone | 3522833568 |
| Practice Fax Number | 9042173081 |
| Mailing Telephone | 3524161082 |
| Mailing Fax Number | 3523736144 |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-08-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | 40009 | KY | Allopathic & Osteopathic Physicians |
| Y | 207LA0401X |
Anesthesiology Specialization: Addiction Medicine |
ME142795 | FL | Allopathic & Osteopathic Physicians |
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
ME142795 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ANTHEM | 000000566553 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134755721 | Mark Wayne Jackson | Occupational Therapist | 8608 Marys Creek Dr, Benbrook, TX 76116-7624 | 2020-03-16 |
| 1811409535 | Mark Jackson | Driver | 26048 Pine Tree Rd, Rhoadesville, VA 22542-8549 | 2017-11-03 |
| 1932488194 | Mark Monroe Jackson | Social Worker | 119 Kona Dr, Galveston, TX 77554-8623 | 2011-08-05 |
| 1477860757 | Mark Allan Jackson | Technician, Other | 322 S Jefferson St, Louisa, KY 41230-1316 | 2010-09-08 |
| 1063620516 | Mark Kent Jackson | Pharmacist | 605 Hwy 31 South, Suite D, Athens, AL 35611 | 2007-05-18 |
| 1528289881 | Mark Jackson | Preventive Medicine | 10 Standing Rock Agency Avenue, Fort Yates, ND 58538 | 2007-05-02 |
| 1598788796 | Mark K Jackson | Dentist | 7007 Old Sauk Road, Madison, WI 53717 | 2006-07-26 |
| 1003877077 | Mark R. Jackson | Emergency Medicine | 1474 E Erda Way, Tooele, UT 84074-9737 | 2006-03-30 |
| 1073585238 | Mark A Jackson | Family Medicine | 1000 Pavilions Circle, Mark A Jackson Md Plc, Traverse City, MI 49684 | 2006-02-02 |
| 1023015005 | Mark D Jackson | Optometrist | 1250 E Magnolia St, Fort Collins, CO 80524-2702 | 2005-07-05 |
| Street Address |
3930 US 1 S |
| City | SAINT AUGUSTINE |
| State | FL |
| Zip Code | 32086-7089 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225670037 | Ramonica Flagler | Nurse Practitioner | 3574 Us-1 South, St. Augustine, FL 32086 | 2019-10-14 |
| 1518522648 | Marissa Marie Lynch | Physician Assistant | 100 Whetstone Pl Ste 102, St Augustine, FL 32086 | 2019-05-03 |
| 1346706991 | Castillo Transportation | Non-emergency Medical Transport (VAN) | 295 North Hidden Tree Dr, Saint Augustine, FL 32086 | 2019-02-19 |
| 1790255842 | Michelle Moore | In Home Supportive Care | 135 Jenkins St. Suite 105b #265, St.augustine, FL 32086 | 2018-12-03 |
| 1649740200 | Paul James Lietz IIi | Physical Therapist | One Orthopedic Place, Saint Augustine, FL 32086 | 2018-11-27 |
| 1548764707 | Oceanside Endodontics Od St. Augustine | Dentist | 2510 U.S. 1 South, Suite B, St. Augustine, FL 32086 | 2018-03-22 |
| 1023538329 | Joseph R Edwards | Physical Therapist | 968 Espinado Avenue, St Augustine, FL 32086 | 2017-06-27 |
| 1235662032 | Jennifer L Csenge | Dentist | 4327 Us Highway 1 S, St Augustine, FL 32086 | 2017-04-07 |
| 1336683663 | Lisa Brice | Social Worker | 248 Southpark Circle East, Saint Augustine, FL 32086 | 2016-12-06 |
| 1558813303 | Bio-medical Applications of Florida, Inc. | Clinic/Center | 65 Whitehall Drive, Saint Augustine, FL 32086 | 2016-10-27 |
| Find all providers in zip 32086 | ||||
| Taxonomy Code | 207LA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Addiction Medicine |
| An anesthesiologist who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417386624 | Ocean Addiction Recovery Services, LLC | Anesthesiology | 1705 19 Pl, Ste E-2, Vero Beach, FL 32960 | 2013-11-07 |
| 1174863757 | Total Patient Care of Ocala, Inc. | Anesthesiology | 3320 Sw 33rd Road, Suite 200, Ocala, FL 34474-7427 | 2013-02-19 |
| 1841422797 | Douglas W Moreland | Anesthesiology | 1705 19th Pl Ste E2, Vero Beach, FL 32960-0688 | 2009-08-11 |
| 1447474390 | Terel S Newton | Anesthesiology | 9191 R G Skinner Pkwy Unit 303, Jacksonville, FL 32256-9658 | 2007-04-12 |
| 1356339840 | Su-min Oon | Anesthesiology | 1131 Nw 64th Ter, Suite C, Gainesville, FL 32605-4218 | 2005-10-10 |
| 1679568182 | Lester N Hauge | Anesthesiology | 2416 Lynndale Rd, Suite 110, Fernandina Beach, FL 32034-5252 | 2005-09-12 |
| 1467454322 | Anthony Otis Russell | Anesthesiology | 2727 Capital Medical Blvd, Tallahassee, FL 32308-4403 | 2005-08-11 |
| 1891315859 | Sanjay Sastry Md Pa | Anesthesiology | 612 Palmetto St, New Smyrna Beach, FL 32168-7327 | 2020-04-20 |
| 1790344927 | Tallahassee Memorial Healthcare Inc | Anesthesiology | 2727 Capital Medical Blvd, Tallahassee, FL 32308-4403 | 2019-06-11 |
| 1356881213 | Thomas Raulerson Md and Farm Inc | Anesthesiology | 926 Nw 13th St, Gainesville, FL 32601-4140 | 2017-02-27 |
| Find all providers with the same taxonomy | ||||
| City | SAINT AUGUSTINE |
| Zip Code | 32086 |
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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.