Active NPI
Tara Lynn Knotts, RPH
- Community/Retail Pharmacy
- Jacksonville, FL
National Provider Identifier
1295331643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Practice address
- 5972 University Blvd W
Jacksonville, FL 32216-4912 - Phone
- (904) 419-5670
- NPI assigned
- Dec 10, 2020
- 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 |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
5972 University Blvd W
Jacksonville, FL 32216-4912
Mailing address
5972 University Blvd W
Jacksonville, FL 32216-4912
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 026625600 | Medicaid | FL |
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
- Credentials
- Registered Pharmacist
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holiday CVS LLC | Community/Retail Pharmacy | Past | Accepting new patients |
| Holiday CVS L.L.C. | Community/Retail Pharmacy | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607558400000",
"number": "1295331643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5972 UNIVERSITY BLVD W",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322164912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5972 UNIVERSITY BLVD W",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322164912",
"telephone_number": "904-419-5670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNOTTS",
"first_name": "TARA",
"middle_name": "LYNN",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-10",
"last_updated": "2020-12-10",
"certification_date": "2020-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "026625600",
"state": "FL"
}
],
"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 Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.