NPIMap

Organization Active NPI

Florida Infectious Disease Associates PA

  • Family Nurse Practitioner
  • Orange Park, FL
National Provider Identifier
1124214879
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
FLORIDA INFECTIOUS DISEASE ASSOCIATES PA
Practice address
1563 Kingsley Ave Ste 106
Orange Park, FL 32073-4503
Phone
(904) 272-6161
Fax
(904) 389-5332
NPI assigned
Sep 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2026

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

Authorized official

Name
Janet Yates, RMA
Title
Credentials Specialist
Phone
(904) 389-5333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

1563 Kingsley Ave Ste 106
Orange Park, FL 32073-4503

Mailing address

2 Shircliff Way Ste 700
Jacksonville, FL 32204-4759
Phone (904) 389-5333

Other identifiers 1

IdentifierTypeStateIssuer
110282800MedicaidFL

Other names 2

  • Florida Infectious Disease Associates PA Doing business as
  • Nephrology Associates of Northeast Florida Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041106000136 FL Part B Supplier - Clinic/Group Practice 3971566365 Receives reassigned benefits from 9 practitioners
Practice locations: Orange Park, FL

National Provider Directory

National Provider Directory

Locations

1658 St Vincents Way
Ste 120
Middleburg, FL 32068
Phone (904) 602-1000

1555 Kingsley Ave
Ste 201
Orange Park, FL 32073
Phone (904) 264-7132

2021 Kingsley Ave
Ste 101
Orange Park, FL 32073
Phone (904) 276-3376

1536 Kingsley Ave
Ste 118119
Orange Park, FL 32073

1563 Kingsley Ave
Ste 106
Orange Park, FL 32073
Phone (904) 272-6161

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775433600000",
    "number": "1124214879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 SHIRCLIFF WAY STE 700",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044759",
            "telephone_number": "904-389-5333",
            "fax_number": "904-389-5332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1563 KINGSLEY AVE STE 106",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734503",
            "telephone_number": "904-272-6161",
            "fax_number": "904-389-5332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA INFECTIOUS DISEASE ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-17",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A",
        "authorized_official_last_name": "YATES",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "CREDENTIALS SPECIALIST",
        "authorized_official_telephone_number": "904-389-5333",
        "authorized_official_credential": "RMA"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110282800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Infectious Disease Associates PA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nephrology Associates of Northeast Florida",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.