Active NPI
Nicole Eller
- Developmental Therapist
- Jacksonville, FL
National Provider Identifier
1033723481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 6907 Pickettville Rd
Jacksonville, FL 32220-2475 - Phone
- (904) 510-2079
- NPI assigned
- Sep 3, 2020
- 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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary | ||
| Behavior Technician | 106S00000X | RBT-20-133075 | FL |
Addresses
Primary practice location
6907 Pickettville Rd
Jacksonville, FL 32220-2475
Mailing address
5 Revere Dr Ste 120
Northbrook, IL 60062-8005
Phone (800) 356-4049
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-20-133075 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719964800000",
"number": "1033723481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 REVERE DR STE 120",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600628005",
"telephone_number": "800-356-4049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6907 PICKETTVILLE RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322202475",
"telephone_number": "904-510-2079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLER",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-03",
"last_updated": "2024-07-03",
"certification_date": "2024-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-20-133075",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.