IMPACT 13 MEDICAL, PLLC (NPI# 1548805617) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1548805617 |
Entity Type | Organization |
Organization Name | IMPACT 13 MEDICAL, PLLC |
Practice Address |
10752 Deerwood Park Blvd South Waterview II Suite 100 Jacksonville FL 32256 |
Mailing Address |
10752 Deerwood Park Blvd South Waterview II Suite 100 Jacksonville FL 32256-8666 |
Practice Telephone | 9047551017 |
Practice Fax Number | 6467740386 |
Mailing Telephone | 9047551017 |
Mailing Fax Number | 6467740386 |
Enumeration Date | 2019-11-13 |
Last Update Date | 2019-12-18 |
Authorized Official Name | DR. WIL E GERMAIN (OWNER) |
Authorized Official Telephone | 5164121608 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
Allopathic & Osteopathic Physicians | ||
N | 2084P0805X |
Psychiatry & Neurology Specialization: Geriatric Psychiatry |
Allopathic & Osteopathic Physicians | ||
N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
Street Address |
10752 DEERWOOD PARK BLVD SOUTH WATERVIEW II SUITE 100 |
City | JACKSONVILLE |
State | FL |
Zip Code | 32256 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982701520 | Anthony Serle | Chiropractor | 10752 Deerwood Park Blvd, Suite 100, Jacksonville, FL 32256-4849 | 2006-09-17 |
1134652472 | Michael Bauer | Behavior Technician | 10752 Deerwood Park Blvd, Suite 100, Jacksonville, FL 32256-4849 | 2017-04-04 |
1164965158 | Therapy-interventions | Counselor | 10752 Deerwood Park Blvd, Suite, Jacksonville, FL 32256-4849 | 2016-11-23 |
1720432099 | Trading-interventions | Counselor | 10752 Deerwood Park Blvd, Suite 100, Jacksonville, FL 32256-4849 | 2016-04-22 |
1023462710 | Colleen H Wright Lmhc | Counselor | 10752 Deerwood Park Blvd, Suite 100, Jacksonville, FL 32256-4849 | 2016-04-19 |
1659613685 | Kd's Helping Hand Home Care, LLC | Home Health | 10752 Deerwood Park Blvd, Suite 100, Jacksonville, FL 32256-4849 | 2013-03-15 |
1720348592 | Wil Edvard Germain | Psychiatry & Neurology | 10752 Deerwood Park Blvd, South Waterview II Suite 100, Jacksonville, FL 32256-4849 | 2012-05-25 |
1417144452 | Sandi Lea Sage | Counselor | 10752 Deerwood Park Blvd, Suite 100, Jacksonville, FL 32256-4849 | 2007-10-03 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1841890464 | Alice Sanchez | Dietitian, Registered | 7643 Gate Parkway, Suite 104-1128, Jacksonville, FL 32256 | 2020-11-01 |
1093327702 | Oaktree Dental LLC | Clinic/Center | 14595 Philips Highway, Jacksonville, FL 32256 | 2020-08-24 |
1538787866 | Tywanna Council | Massage Therapist | 4720 Salisbury Road #102, Jacksonville, FL 32256 | 2020-07-13 |
1275155368 | Christy Orellana | Social Worker | 5011 Gate Parkway Bldg 100 Suite 100, Jacksonville, FL 32256 | 2020-05-11 |
1376175117 | Diane Stover | Case Manager/Care Coordinator | 7001 A. C. Skinner Parkway, Jacksonville, FL 32256 | 2020-02-10 |
1982235859 | Sandra Josefina Baez Nunez | Nurse Practitioner | 10739 Deerwood Park Blvd, Suite 200, Jacksonville, FL 32256 | 2020-01-30 |
1205476496 | Point Meadows Dental Center, Inc. | Dentist | 10915 Baymeadows Rd, #106, Jacksonville, FL 32256 | 2020-01-15 |
1598324113 | Dhaval Yogeshkumar Shah | Dentist | 8206 Philips Hwy., Suite 21, Jacksonville, FL 32256 | 2019-06-07 |
1003472499 | Dade Medical, Inc. | Durable Medical Equipment & Medical Supplies | 9143 Philips Highway Suite 270, Jacksonville, FL 32256 | 2019-05-13 |
1003479726 | Nichole Bashara | Behavior Technician | 8383 Baymeadows Rd, Jacksonville, FL 32256 | 2019-04-18 |
Find all providers in zip 32256 |
Taxonomy Code | 2084N0400X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Neurology |
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1285138495 | Yulia Salamatova | Psychiatry & Neurology | 580 W 8th St # T17, Jacksonville, FL 32209-6533 | 2018-03-21 |
1619471018 | William Joseph Scharpf | Psychiatry & Neurology | 653-1 West 8th Street, L18, 4th Floor, Lrc, Jacksonville, FL 32209 | 2018-03-20 |
1184155616 | Kyle Wuthrich | Psychiatry & Neurology | 580 W 8th St Fl 9, Jacksonville, FL 32209-6533 | 2017-03-26 |
1932511235 | Shannon Laboy | Psychiatry & Neurology | 580 W 8th St # T1-9t17, Jacksonville, FL 32209-6533 | 2014-05-21 |
1174933147 | Caitlin E D'souza | Psychiatry & Neurology | 14540 Old Saint Augustine Rd Ste 216, Jacksonville, FL 32258-7418 | 2014-04-30 |
1235416322 | Benjamin E Moore Md Pa | Psychiatry & Neurology | 2 Shircliff Way Ste 925, Jacksonville, FL 32204-4711 | 2011-11-03 |
1598995599 | Baptist Neurology Inc | Psychiatry & Neurology | 3563 Phillips Hwy Ste 106a, Jacksonville, FL 32207-5663 | 2009-07-24 |
1316104722 | Candice Waked Riggeal | Psychiatry & Neurology | 841 Prudential Dr 10th Floor, Jacksonville, FL 32207-8329 | 2008-05-22 |
1508089194 | James Gordon Creveling Jr | Psychiatry & Neurology | 7842 Monterey Bay Dr, Jacksonville, FL 32256-2936 | 2007-04-11 |
1053471987 | Mark K Emas | Psychiatry & Neurology | 4085 University Blvd South, # 3, Jacksonville, FL 32216 | 2006-12-11 |
Find all providers in JACKSONVILLE |
City | JACKSONVILLE |
Zip Code | 32256 |
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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.