Active NPI
Sherene Wilson, PA
- Physician Assistant
- Jacksonville, FL
National Provider Identifier
1295019925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9106036
- Practice address
- 4311 Salisbury Rd
Jacksonville, FL 32216-6123 - Phone
- (904) 332-4300
- Fax
- (904) 332-4339
- NPI assigned
- Sep 29, 2011
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9106036 | FL | Primary |
Addresses
Primary practice location
4311 Salisbury Rd
Jacksonville, FL 32216-6123
Mailing address
4311 Salisbury Rd
Jacksonville, FL 32216-6123
Phone (904) 332-4300
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Oliver Emergency Group, LLC | Physician Assistant | Current | Accepting new patients |
| Old Fields Emergency Physicians, LLC | Past | Accepting new patients |
Locations
23186 Blue Star Hwy
Quincy, FL 32351
Phone (850) 875-5977
2626 Capital Medical Blvd
Tallahassee, FL 32308
Phone (850) 325-5000
Interoperability endpoints
- sherene.wilson@hca5.eclinicaldirectplus.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 and National Provider Directory roles.
-
- Emergency Medicine Physician
- Tallahassee, FL
- NPI 1013675016
-
- Emergency Medicine Physician
- Winter Haven, FL
- NPI 1912101650
-
- Family Medicine Physician
- Gulf Breeze, FL
- NPI 1235775396
-
- Multi-Specialty Clinic/Center
- Gulf Breeze, FL
- NPI 1689557936
-
- Emergency Medicine Physician
- Tallahassee, FL
- NPI 1548921034
Physician Assistant
-
- Emergency Medicine Physician
- Tallahassee, FL
- NPI 1447692926
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317254400000",
"number": "1295019925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4311 SALISBURY RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322166123",
"telephone_number": "904-332-4300",
"fax_number": "904-332-4339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4311 SALISBURY RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322166123",
"telephone_number": "904-332-4300",
"fax_number": "904-332-4339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SHERENE",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-29",
"last_updated": "2011-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9106036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2011; 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.