Individual provider Active NPI

Miranda Loren Jackson, DNP

  • Nurse Practitioner
  • Pensacola, FL
National Provider Identifier
1104609619
Registry record updated Feb 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN11026888 Issued in FL
Practice address
9400 University Pkwy Ste 210
Pensacola, FL 32514-5485
Phone
(448) 227-4240
Fax
(850) 208-6369
NPI assigned
Aug 17, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11026888 FL
Nurse Practitioner 363L00000X APRN11026888 FL Primary

Addresses

Primary practice location

9400 University Pkwy Ste 210
Pensacola, FL 32514-5485

Mailing address

PO Box 95590
South Jordan, UT 84095-0590
Phone (801) 352-9500

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231114000768 FL Practitioner - Nurse Practitioner 4385091305 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Medical Group LLCGroup PAC ID 9638215734, 258 clinicians

Practice addresses (Care Compare)

9400 University Pkwy
Pensacola, FL 32514-5485
Phone (850) 994-7256

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Pensacola, FL, CCN 107792
  • Baptist Home Health Care Home health agency, Pensacola, FL, CCN 107006
  • Baptist Hospital Hospital, Pensacola, FL, CCN 100093
  • Gulf Breeze Hospital Hospital, Gulf Breeze, FL, CCN 100266

Merit-based Incentive Payment System (MIPS)

Final score
81.01 of 100Reported as group
Quality
62.34
Promoting interoperability
95
Improvement activities
40
Cost
78.51

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11026888FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Medical Group LLC CurrentSince Nov 1, 2023 Accepting new patients
Baptist Medical Group LLC CurrentSince Nov 1, 2023 Accepting new patients

Locations

1200 Henley Ln
Baker, FL 32531
Phone (850) 537-8555

9400 University Pkwy
Ste 409
Pensacola, FL 32514
Phone (850) 994-7256

9400 University Pkwy
Ste 210
Pensacola, FL 32514
Phone (448) 227-4240

Organizations & group practices 2

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1104609619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95590",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840950590",
            "telephone_number": "801-352-9500",
            "fax_number": "801-352-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 UNIVERSITY PKWY STE 210",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325145485",
            "telephone_number": "448-227-4240",
            "fax_number": "850-208-6369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MIRANDA",
        "middle_name": "LOREN",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-17",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11026888",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11026888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.