Individual provider Active NPI

Sally Austill Bardin, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1184577694
Registry record updated Jun 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1550 Riverside Ave Ste a
Jacksonville, FL 32204-4162
Phone
(904) 923-6647
Fax
(904) 355-7788
NPI assigned
Feb 16, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X FL Primary

Addresses

Primary practice location

1550 Riverside Ave Ste a
Jacksonville, FL 32204-4162

Mailing address

1550 Riverside Ave Ste a
Jacksonville, FL 32204-4162
Phone (904) 923-6647

Other practice location 1

1209 Park Ave
Orange Park, FL 32073-4158
Phone (904) 923-6647

Other practice location 2

600 Zeagler Dr
Palatka, FL 32177-3811
Phone (904) 923-6647

Other practice location 3

159 N 3rd St
Macclenny, FL 32063-2103
Phone (904) 923-6647

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
I20260520000126 FL Practitioner - Physician Assistant 5294204103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Lincoln Memorial University Medical Department, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Precision Dermatology and Skin Surgery PAGroup PAC ID 1153547989, 7 clinicians

Practice addresses (Care Compare)

1550 Riverside Ave
Suite a
Jacksonville, FL 32204-4162
Phone (904) 923-6647

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Precision Dermatology and Skin Surgery PA CurrentSince Apr 13, 2026 Accepting new patients

Locations

1550 Riverside Ave
Ste A
Jacksonville, FL 32204
Phone (904) 613-3996

1209 Park Ave
Orange Park, FL 32073
Phone (904) 278-7012

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1771200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780963200000",
    "number": "1184577694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 RIVERSIDE AVE STE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044162",
            "telephone_number": "904-923-6647",
            "fax_number": "904-355-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 RIVERSIDE AVE STE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044162",
            "telephone_number": "904-923-6647",
            "fax_number": "904-355-7788"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1209 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Orange Park",
            "state": "FL",
            "postal_code": "320734158",
            "country_code": "US",
            "telephone_number": "904-923-6647",
            "fax_number": "904-355-7788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Zeagler Dr",
            "address_purpose": "LOCATION",
            "city": "Palatka",
            "state": "FL",
            "postal_code": "321773811",
            "country_code": "US",
            "telephone_number": "904-923-6647",
            "fax_number": "904-355-7788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "159 N 3rd St",
            "address_purpose": "LOCATION",
            "city": "Macclenny",
            "state": "FL",
            "postal_code": "320632103",
            "country_code": "US",
            "telephone_number": "904-923-6647",
            "fax_number": "904-355-7788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BARDIN",
        "first_name": "SALLY",
        "middle_name": "AUSTILL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-16",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.