Audrey Lee Farson Jackson, APRN

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

APRN11026952 Issued in FL

Practice address

1223 Gateway Dr Ste 1D
Melbourne, FL 32901-2607

Phone

(321) 729-6166

Fax

(321) 722-1237

NPI assigned

Apr 12, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Health First Medical Group, LLCGroup PAC ID 7416100672, 701 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holmes Regional Medical Center Hospital, Melbourne, FL, CCN 100019
• Cape Canaveral Hospital Hospital, Cocoa Beach, FL, CCN 100177
• Viera Hospital Hospital, Melbourne, FL, CCN 100315

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ajackson69122@epicdirect.hf.org

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.

• Health First Medical Group, LLC

  • General Practice Physician
  • Melbourne, FL
  • NPI 1750626495
  Medicare reassignment Care Compare group NPD
• Health First Medical Group, LLC

  • General Practice Physician
  • Rockledge, FL
  • NPI 1073268934
  NPD
• Womencare PA

  • Specialist
  • Orlando, FL
  • NPI 1366529042
  NPD (past)

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

• Cape Canaveral Hospital, Inc.

  • General Acute Care Hospital
  • Cocoa Beach, FL
  • NPI 1184691610
  Care Compare affiliation
• Holmes Regional Medical Center, Inc.

  • Air Ambulance
  • Melbourne, FL
  • NPI 1235312281

  Hospital

  Care Compare affiliation
• Holmes Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Melbourne, FL
  • NPI 1295702728
  Care Compare affiliation
• Viera Hospital Inc

  • General Acute Care Hospital
  • Melbourne, FL
  • NPI 1730494816
  Care Compare affiliation

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

{
    "created_epoch": "1618185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1114507332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554306",
            "telephone_number": "321-729-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 GATEWAY DR STE 1D",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012607",
            "telephone_number": "321-729-6166",
            "fax_number": "321-722-1237"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3425 Bayside Lakes Blvd SE Ste 110",
            "address_purpose": "LOCATION",
            "city": "Palm Bay",
            "state": "FL",
            "postal_code": "329096867",
            "country_code": "US",
            "telephone_number": "321-729-6166",
            "fax_number": "321-722-1237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AUDREY",
        "middle_name": "LEE FARSON",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-12",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "FL",
            "license": "APRN11026952",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "APRN11026952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE HF",
            "identifier": "SA065",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120782400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abdimomun Iuldashev, M.D.
• Andrea Izquierdo, DOM, LAC
• J Phyllis Brannen LCSW Cap
• Amber Jack, APRN
• Susan J Jacksland, OTR
• Jessica Jackson
• Tiye Jackson, PTA
• Valerie P. Jackson, MA
• William Lemar Jackson Jr., MD
• Daryl Clayton Jacobs II, DPT, MTC, ATC

• Primary Care Nurse Practitioner in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Primary Care Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.