Tina F Jaeckle, PH.D.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW6154 Issued in FL

Practice address

4088 Coyote CT
Middleburg, FL 32068-2225

Phone

(904) 237-2008

NPI assigned

Nov 28, 2021

Last updated

Aug 1, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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

• Responder Support Services

  • Professional Counselor
  • Asheville, NC
  • NPI 1881196418
  NPD (past)

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

{
    "created_epoch": "1638057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1033876974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4088 COYOTE CT",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320682225",
            "telephone_number": "904-237-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4088 COYOTE CT",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320682225",
            "telephone_number": "904-237-2008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "204 Charlotte Hwy Ste E",
            "address_purpose": "LOCATION",
            "city": "Asheville",
            "state": "NC",
            "postal_code": "288038681",
            "country_code": "US",
            "telephone_number": "828-333-5708",
            "fax_number": "828-484-1025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAECKLE",
        "first_name": "TINA",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-28",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C018742",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW6154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1041C0700X",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Osman Ismaeel
• Angela Issa
• Ronnika Michelle Jackson-Dillon, PHARMD
• Nicole Jackson
• Victoria Ann Jacobs, APRN
• Breanna Nicole James, DNP APRN FNP-BC
• Steven Charles Janowicz
• Taquan Johnson
• Alexa Jones, LMHC
• Ashley Jones, RN

• Clinical Social Worker in Middleburg, FL
• Providers in Middleburg, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.