Active NPI
Chantal Jackqueline Cobb
- Contractor
- Jacksonville, FL
National Provider Identifier
1083804462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- PTA 18829
- Practice address
- 5816 Dickson Rd
Jacksonville, FL 32211-4600 - Phone
- (904) 993-7048
- Fax
- (904) 744-0293
- NPI assigned
- Jul 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | PTA 18829 | FL | Primary |
Addresses
Primary practice location
5816 Dickson Rd
Jacksonville, FL 32211-4600
Mailing address
5816 Dickson Rd
Jacksonville, FL 32211-4600
Phone (904) 993-7048
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 |
|---|---|---|---|
| PTA 18829 | FL | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185840000000",
"number": "1083804462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5816 DICKSON RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322114600",
"telephone_number": "904-993-7048",
"fax_number": "904-744-0293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5816 DICKSON RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322114600",
"telephone_number": "904-993-7048",
"fax_number": "904-744-0293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COBB",
"first_name": "CHANTAL",
"middle_name": "JACKQUELINE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-31",
"last_updated": "2007-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "FL",
"license": "PTA 18829",
"primary": true
}
],
"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 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.