Active NPI
Doreen Radjenovic, ARNP
- Nurse Practitioner
- Jacksonville, FL
National Provider Identifier
1033200043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- ARNP1607022
- Practice address
- 807 Childrens Way
Jacksonville, FL 32207-8426 - Phone
- (904) 390-3759
- Fax
- (904) 390-3429
- NPI assigned
- Sep 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | ARNP1607022 | FL | |
| Nurse Practitioner | 363L00000X | ARNP1607022 | FL | Primary |
Addresses
Primary practice location
807 Childrens Way
Jacksonville, FL 32207-8426
Mailing address
PO Box 191
Provider Enrollment Dept
Rockland, DE 19732-0191
Phone (302) 651-6212
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 257733000 | Medicaid | FL | |
| 783679869A | Medicaid | GA |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ARNP1607022 | FL | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316131200000",
"number": "1033200043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 191",
"address_2": "PROVIDER ENROLLMENT DEPT",
"city": "ROCKLAND",
"state": "DE",
"postal_code": "197320191",
"telephone_number": "302-651-6212",
"fax_number": "302-651-4945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "807 CHILDRENS WAY",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078426",
"telephone_number": "904-390-3759",
"fax_number": "904-390-3429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADJENOVIC",
"first_name": "DOREEN",
"name_prefix": "Dr.",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-27",
"last_updated": "2011-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "FL",
"license": "ARNP1607022",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "FL",
"license": "ARNP1607022",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "257733000",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "783679869A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
- Radiant Midwifery, LLC
- Radiology Consultants of Hollywood Inc
- Radiology Consultants of Jacksonville MRI
- Radiology Health Imaging, LLC
- Radiology Specialists of North Florida
- Blaine Radley, DDS
- Mohamed Omar Radwan, M.D.
- Vener Sentones Rafael, RPT
- Anna M Rafanan, MD
- Kaitlin Danielle Rafay, NURSE PRACTITIONER
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.