Jacksonville Pediatrics World Golf Village PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

JACKSONVILLE PEDIATRICS WORLD GOLF VILLAGE PLLC

Practice address

130 Land Grant Street
Suite 3
St Augustine, FL 32092

Phone

(904) 388-4646

NPI assigned

Apr 18, 2025

Last updated

Apr 18, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ryan C Cantville, DONPI 1508156795

Title

Physician

Phone

(904) 388-4646

Specialties & licenses 1

Addresses

Other names 1

• Jacksonville Pediatrics Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan Cantville, D.O.

  • Pediatrics Physician
  • Jacksonville, FL
  • NPI 1508156795
  NPD Authorized official

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

{
    "created_epoch": "1744934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744934400000",
    "number": "1275329823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2606 PARK ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044520",
            "telephone_number": "904-388-4646",
            "fax_number": "904-388-9017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 LAND GRANT STREET",
            "address_2": "SUITE 3",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "32092",
            "telephone_number": "904-388-4646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE PEDIATRICS WORLD GOLF VILLAGE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-18",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A",
        "authorized_official_last_name": "CANTVILLE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "904-388-4646",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacksonville Pediatrics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Julia Elaine Jackson
• Mark F Jackson, M.D.
• Sandra Jackson, LMHC
• Jacksonville BH Services, LLC (Coastal Pines Behavioral Health)
• Jacksonville Orthopaedic Institute Inc
• Jacksonville Spine Center PA (Jax Spine & Pain Centers)
• Jamie Frances Jacobsen, MOT
• Jennifer E Jacobsen, LMT
• Jacqueline Meredith LMHC LLC
• Christin Jalali

• Primary Care Clinic/Center in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.