Individual provider Active NPI

Nicole De Graw

  • Family Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1265244719
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11034640 Issued in FL
Practice address
6817 Southpoint Pkwy Ste 203
Jacksonville, FL 32216-6286
Phone
(813) 606-5315
NPI assigned
Jan 22, 2025
Last updated
Jan 22, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11034640 FL Primary

Addresses

Primary practice location

6817 Southpoint Pkwy Ste 203
Jacksonville, FL 32216-6286

Mailing address

6817 Southpoint Pkwy Ste 203
Jacksonville, FL 32216-6286

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
I20250204003962 FL Practitioner - Nurse Practitioner 0446780555 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cardiac Vision LLCGroup PAC ID 9032349733, 66 clinicians

Practice addresses (Care Compare)

6817 Southpoint Pkwy
Suite 203
Jacksonville, FL 32216-6286
Phone (904) 231-1204

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11034640FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiac Vision LLC CurrentSince Dec 1, 2024 Accepting new patients

Locations

6817 Southpoint Pkwy
Ste 203
Jacksonville, FL 32216
Phone (904) 256-9202

7807 Baymeadows Rd E
Ste 209
Jacksonville, FL 32256
Phone (904) 231-1204

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1737504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1265244719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6817 SOUTHPOINT PKWY STE 203",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6817 SOUTHPOINT PKWY STE 203",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166286",
            "telephone_number": "813-606-5315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE GRAW",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-22",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11034640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.