Denise Jacks, ARNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

3017972 Issued in FL

Practice address

3691 Clyde Morris Blvd
Port Orange, FL 32129-2317

Phone

(386) 675-4411

Fax

(866) 542-5859

NPI assigned

Oct 17, 2010

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

Medicare fee-for-service enrollment

Enrolled in FL, TX2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Conviva Medical Center Management LLC

  • Internal Medicine Physician
  • Miami, FL
  • NPI 1649324278
  Medicare reassignment NPD
• Magnolia Family Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Ocala, FL
  • NPI 1588038749
  Medicare reassignment NPD
• VMD Primary Providers Central Florida PLLC

  • Family Medicine Physician
  • Saint Cloud, FL
  • NPI 1134738974
  Medicare reassignment NPD
• Tulalip Tribes of Washington

  • General Practice Physician
  • Tulalip, WA
  • NPI 1770531501

  TX

  Medicare reassignment NPD
• VMD Primary Providers Central Florida PLLC

  • Family Medicine Physician
  • Pinellas Park, FL
  • NPI 1053077560
  NPD
• Tulalip Tribes of Washington

  • Public Health & General Preventive Medicine Physician
  • Tulalip, WA
  • NPI 1831325687
  NPD
• Tulalip Tribes of Washington

  • Optometrist
  • Tulalip, WA
  • NPI 1831946797
  NPD
• Img Medical Group de PA

  • Sports Medicine (Family Medicine) Physician
  • Boynton Beach, FL
  • NPI 1720708589
  NPD (past)
• VMD Primary Providers Central Florida PLLC

  • Family Medicine Physician
  • Clermont, FL
  • NPI 1780342618
  NPD (past)

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

{
    "created_epoch": "1287273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1104136738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3691 CLYDE MORRIS BLVD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321292317",
            "telephone_number": "386-675-4411",
            "fax_number": "866-542-5859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKS",
        "first_name": "DENISE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-17",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "3017972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Insightful Therapeutic Solutions LLC
• David Michel Iskandar
• Isner Chiropractic Clinic, Inc.
• J. Kim Periodontics, LLC
• J. Michael Panczyszyn, D.D.S., PA
• Jon C Jackson, M.D.
• Serenity Leilani Jackson, OTR
• Deric L Jacobs, DC
• Jessica Jacobsen
• Abbie Conrad James, LMHC

• Adult Health Nurse Practitioner in Port Orange, FL
• Providers in Port Orange, 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 Jan 16, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.