Anita Dionne Jackson

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

30212414 Issued in FL

Practice address

29 Baltimore LN
Palm Coast, FL 32137-8851

Phone

(386) 264-1398

Fax

(386) 303-5536

NPI assigned

Nov 29, 2018

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 names 1

• Anita Dionne Jackson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Heart of Carrie LLC

  • Home Health Agency
  • Palm Coast, FL
  • NPI 1558086629
  NPD Authorized official

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

{
    "created_epoch": "1543449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1134699481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 OLD KINGS RD N STE E",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378283",
            "telephone_number": "386-264-1398",
            "fax_number": "386-303-5536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 BALTIMORE LN",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378851",
            "telephone_number": "386-264-1398",
            "fax_number": "386-303-5536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANITA",
        "middle_name": "DIONNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-29",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "30212414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANITA",
            "last_name": "JACKSON",
            "middle_name": "DIONNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sofond IV
• Christine M Ivankiv, MS CCC-SLP
• J & B Medical Transport LLC
• Susan Marie Jabs
• Alyssa Jackson
• Donna Kay Jackson
• Jade Jackson, L.D.O
• Jeremy Jackson
• Ronald F Jacob, DDS
• Andrew T Jacquay, DPT

• Home Health Agency in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.