Jeltsje Willemien Derksen, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT17923 Issued in FL

Practice address

4131 University Blvd S
Suite 17
Jacksonville, FL 32216-4326

Phone

(904) 722-1515

Fax

(904) 722-1517

NPI assigned

Feb 15, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276819200000",
    "number": "1043353410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1157 LINKSIDE CT E",
            "city": "ATLANTIC BEACH",
            "state": "FL",
            "postal_code": "322334386",
            "telephone_number": "904-982-2193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131 UNIVERSITY BLVD S",
            "address_2": "SUITE 17",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164326",
            "telephone_number": "904-722-1515",
            "fax_number": "904-722-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERKSEN",
        "first_name": "JELTSJE",
        "middle_name": "WILLEMIEN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2010-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT17923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "889647000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Melissa Derr, PA-C
• Leanne Derrico, ARNP

• Physical Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; 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.