Active NPI
Haneen Sara Ayyoubi, PA-C
- Medical Physician Assistant
- Jacksonville, FL
National Provider Identifier
1134820251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 9117130
- Practice address
- 13241 Bartram Park Blvd Unit 209
Jacksonville, FL 32258-5233 - Phone
- (904) 224-5437
- NPI assigned
- Mar 15, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 9117130 | FL | Primary |
Addresses
Primary practice location
13241 Bartram Park Blvd Unit 209
Jacksonville, FL 32258-5233
Mailing address
8550 Touchton Rd Apt 1112
Jacksonville, FL 32216-2206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9117130 | FL | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678838400000",
"number": "1134820251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8550 TOUCHTON RD APT 1112",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322162206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13241 BARTRAM PARK BLVD UNIT 209",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322585233",
"telephone_number": "904-224-5437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AYYOUBI",
"first_name": "HANEEN",
"middle_name": "SARA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-15",
"last_updated": "2023-03-15",
"certification_date": "2023-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "9117130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.