Anthony Atwood Premo, APRN, AGACNP-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

APRN11020380 Issued in FL

Practice address

14785 Old Saint Augustine Rd Ste 100
Jacksonville, FL 32258-7407

Phone

(904) 456-0017

Fax

(904) 456-0018

NPI assigned

Jun 22, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cleveland W. Randolph, Jr, MD, PAGroup PAC ID 5496749004, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cleveland W Randolph, Jr, MD, PA

  dba Dr. Randolph's Ageless & Wellness Medical Center

  • Specialist
  • Jacksonville Beach, FL
  • NPI 1497808182
  Medicare reassignment Care Compare group NPD
• Integrity Spine and Orthopedics LLC

  • Durable Medical Equipment & Medical Supplies
  • Middleburg, FL
  • NPI 1356108989

  Nurse Practitioner

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1033840806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14785 OLD SAINT AUGUSTINE RD STE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322587407",
            "telephone_number": "904-456-0017",
            "fax_number": "904-456-0018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14785 OLD SAINT AUGUSTINE RD STE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322587407",
            "telephone_number": "904-456-0017",
            "fax_number": "904-456-0018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREMO",
        "first_name": "ANTHONY",
        "middle_name": "ATWOOD",
        "credential": "APRN, AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-22",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11020380",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "APRN11020380",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "APRN11020380",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11020380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premise Health of Florida Medical PA (The DB Health & Wellbeing Center)
• Premise Health of Florida Medical, P.a. (Deutsche Bank Health Unit)
• Premise Health of West Virginia Medical, Medical Corporation (Employee Health Center)
• Premium Care Home Services LLC
• Abby Premo
• Caitlin Premuroso, MD
• Mary Prendergast, MD
• Mary Louise Prendergast, L.M.H.C.
• Gjergji Prendi
• Carmella Maria Prescott, LMHC

• Adult Health Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.