Individual provider Active NPI

Colleen Marie Ware, APRN

  • Family Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1295462083
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11012057 Issued in FL
Practice address
4655 Salisbury Rd Ste 220
Jacksonville, FL 32256-0959
Phone
(904) 570-9404
Fax
(904) 900-2224
NPI assigned
Aug 2, 2022
Last updated
Aug 15, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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 11012057 FL Primary

Addresses

Primary practice location

4655 Salisbury Rd Ste 220
Jacksonville, FL 32256-0959

Mailing address

4655 Salisbury Rd Ste 220
Jacksonville, FL 32256-0959
Phone (904) 570-9404

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
I20220901001954 FL Practitioner - Nurse Practitioner 7911381421 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
My Choice Operating Company LLCGroup PAC ID 3779991542, 60 clinicians

Practice addresses (Care Compare)

4655 Salisbury Rd
Suite 220
Jacksonville, FL 32256-0959
Phone (904) 570-9404

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11012057FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
My Choice Operating Company LLC Single Specialty CurrentSince Aug 29, 2022 Accepting new patients
Mobile Medical Operating Company LLC Single Specialty CurrentSince May 17, 2023 Accepting new patients

Locations

4655 Salisbury Rd
Ste 110
Jacksonville, FL 32256
Phone (904) 570-9404

4655 Salisbury Rd
Ste 220
Jacksonville, FL 32256
Phone (904) 570-9404

4195 SW High Meadows Ave
Palm City, FL 34990
Phone (772) 221-7620

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

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, 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": "1659398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1295462083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 SALISBURY RD STE 220",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560959",
            "telephone_number": "904-570-9404",
            "fax_number": "904-900-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4655 SALISBURY RD STE 220",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560959",
            "telephone_number": "904-570-9404",
            "fax_number": "904-900-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARE",
        "first_name": "COLLEEN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-02",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11012057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.