NPIMap

Individual provider Active NPI

Jeaniacieuse Theodore

  • Family Nurse Practitioner
  • Port Saint Lucie, FL
National Provider Identifier
1285450155
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11036138 Issued in FL
Practice address
1801 SE Hillmoor Dr Ste C104C103
Port Saint Lucie, FL 34952-7553
Phone
(772) 742-2111
NPI assigned
Nov 25, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 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 11036138 FL Primary

Addresses

Primary practice location

1801 SE Hillmoor Dr Ste C104C103
Port Saint Lucie, FL 34952-7553

Mailing address

1701 SE Hillmoor Dr Ste 7
Port Saint Lucie, FL 34952-7552
Phone (772) 480-5860

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250107004119 FL Practitioner - Nurse Practitioner 9234667056 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mobile Medical Operating Company LLCGroup PAC ID 1456747625, 11 clinicians

Practice addresses (Care Compare)

1840 SE Port St Lucie Blvd
Suite 1840
Port St Lucie, FL 34952-5545
Phone (772) 221-7620

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11036138FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Andi's Integrated Health Care,LLC Family CurrentSince Dec 1, 2024 Accepting new patients
Primary Care Solutions & More LLC CurrentSince Dec 1, 2024 Accepting new patients
Harmony Point Care Solutions LLC Family Current Accepting new patients

Locations

1701 SE Hillmoor Dr
Ste 7
Port St Lucie, FL 34952
Phone (772) 398-9808

1801 SE Hillmoor Dr
Ste C-103
Port St Lucie, FL 34952
Phone (772) 398-7110

1860 SW Fountainview Blvd
Ste 100
Port St Lucie, FL 34986
Phone (772) 204-5110

Interoperability endpoints

  • Direct secure messaging: jeaniacieuse.theodore.1@25403.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1732492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1285450155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SE HILLMOOR DR STE 7",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527552",
            "telephone_number": "772-480-5860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 SE HILLMOOR DR STE C104C103",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527553",
            "telephone_number": "772-742-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODORE",
        "first_name": "JEANIACIEUSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-25",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11036138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

Verify at the official NPI Registry.