Travis Nolan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW17486 Issued in FL

Practice address

2200 Marsh Hawk LN Unit 615
Fleming Island, FL 32003-4315

Phone

(904) 294-7247

NPI assigned

Aug 18, 2020

Last updated

Feb 3, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Balanced Wellbeing LLC

  • Psychiatry Physician
  • Ocala, FL
  • NPI 1336513639

  Clinical

  Medicare reassignment NPD
• MCR Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Parrish, FL
  • NPI 1255376000
  Medicare reassignment NPD
• Travis Nolan

  • Clinical Social Worker
  • Jacksonville, FL
  • NPI 1952281040
  NPD Authorized official
• MCR Health, Inc.

  dba Riverside Medical Center

  • Non-Pharmacy Dispensing Site
  • Bradenton, FL
  • NPI 1821878745
  NPD

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1205448560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 MARSH HAWK LN UNIT 615",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320034315",
            "telephone_number": "904-294-7247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 MARSH HAWK LN UNIT 615",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320034315",
            "telephone_number": "904-294-7247"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 N 12th Ave",
            "address_purpose": "LOCATION",
            "city": "Arcadia",
            "state": "FL",
            "postal_code": "342668752",
            "country_code": "US",
            "telephone_number": "863-494-1242",
            "fax_number": "863-491-0466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOLAN",
        "first_name": "TRAVIS",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-18",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "SW17486",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW17486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Nichter
• Avery Ross Nielsen
• Chandler Everett Nielsen
• Jacqueline Kay Nizamoff, OTR CHT
• Kaitlyn Jewel Nolan
• Karlee Butler Norell, PT
• North Florida Sleep Resources (North Florida Sleep and Airway)
• North Florida Surgeons, PA
• Sean Aidan O'Brien
• James M O'Callaghan, PA-C

• Clinical Social Worker in Fleming Island, FL
• Providers in Fleming Island, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.