John C Hackenberg, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS3216 Issued in FL

Practice address

4131 University Blvd S
BLDG #8
Jacksonville, FL 32216-4326

Phone

(904) 733-3992

Fax

(904) 737-4344

NPI assigned

Oct 19, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1083603245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131 UNIVERSITY BLVD S",
            "address_2": "BLDG #8",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164326",
            "telephone_number": "904-733-3992",
            "fax_number": "904-737-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKENBERG",
        "first_name": "JOHN",
        "middle_name": "C",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS3216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Francis Habell, PA-C
• Samantha Nizam Habhab, MD
• Elaheh Habibi, DDS
• Ahmad Hachem, MD
• Daniel Roger Hack, PA-C
• Hannah Hackworth, LCSW
• Judella Edwina Haddad-Lacle, M.D.
• Alexander Afif Haddad, DO
• Ana Luiza Haddad
• Carlene Haddad

• Family Medicine Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.