Active NPI
Jana Renee Shaddix Diaz, PT
- Physical Therapist
- Green Cove Springs, FL
National Provider Identifier
1225596372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT18608
- Practice address
- 3505 Olympic Dr
Green Cove Springs, FL 32043-8079 - Phone
- (904) 302-7268
- NPI assigned
- Mar 7, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT18608 | FL | Primary |
Addresses
Primary practice location
3505 Olympic Dr
Green Cove Springs, FL 32043-8079
Mailing address
3505 Olympic Dr
Green Cove Springs, FL 32043-8079
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 |
|---|---|---|---|
| PT18608 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656374400000",
"number": "1225596372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3505 OLYMPIC DR",
"city": "GREEN COVE SPRINGS",
"state": "FL",
"postal_code": "320438079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3505 OLYMPIC DR",
"city": "GREEN COVE SPRINGS",
"state": "FL",
"postal_code": "320438079",
"telephone_number": "904-302-7268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADDIX DIAZ",
"first_name": "JANA",
"middle_name": "RENEE",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-03-07",
"last_updated": "2022-06-28",
"certification_date": "2022-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT18608",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Cove Springs, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.