NPIMap

Individual provider Active NPI

Jesse Fazzingo, ARNP

  • Family Nurse Practitioner
  • St Augustine, FL
National Provider Identifier
1316487218
Registry record updated Apr 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9241959 Issued in FL
Practice address
1301 Plantation Island Dr S
Suite 302a
St Augustine, FL 32080-3108
Phone
(904) 461-9330
NPI assigned
Feb 27, 2017
Last updated
Apr 20, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2017

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 ARNP9241959 FL Primary

Addresses

Primary practice location

1301 Plantation Island Dr S
Suite 302a
St Augustine, FL 32080-3108

Mailing address

1301 Plantation Island Dr S
Ste 302a
Saint Augustine, FL 32080-3117
Phone (904) 461-9330

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
I20170608001064 FL Practitioner - Nurse Practitioner 8426326893 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
May accept Medicare assignment
Group practices
Mobile Visiting Practitioners, LLCGroup PAC ID 7810239100, 25 clinicians
Kopa LLCGroup PAC ID 5193774461, 40 clinicians
Vitas Solutions IncGroup PAC ID 7012087166, 55 clinicians

Practice addresses (Care Compare)

140 S Beach St
Suite 202
Daytona Beach, FL 32114-4409
Phone (888) 506-8836

5900 Lake Ellenor Dr
Suite 700
Orlando, FL 32809-4643
Phone (407) 352-2542

7406 Fullerton St
Suite 105
Jacksonville, FL 32256-3588
Phone (877) 868-4827

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ashfaq Kudia, M.D., P.a. CurrentSince Apr 1, 2017 Accepting new patients
Mobile Visiting Practitioners, LLC CurrentSince May 22, 2019 Accepting new patients
Kopa LLC CurrentSince Sep 22, 2025 Accepting new patients
Behavioral Health Services of Florida LLC CurrentSince Sep 15, 2021 Accepting new patients
Vitas Solutions Inc CurrentSince Jun 1, 2022 Accepting new patients

Locations

140 S Beach St
Ste 202
Daytona Beach, FL 32114
Phone (888) 506-8836

7406 Fullerton St
Ste 105
Jacksonville, FL 32256
Phone (877) 848-2720

2000 N Semoran Blvd
Orlando, FL 32807
Phone (407) 641-5400

5900 Lk Ellenor Dr
Ste 700
Orlando, FL 32809
Phone (407) 216-0101

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

1301 Plantation Island Dr S
Ste 302A
Saint Augustine, FL 32080
Phone (386) 232-9203

Interoperability endpoints

  • Direct secure messaging: jesse.fazzingo@199.emedpractice.direct-ci.com
  • Direct secure messaging: jessefazzingo@akmdpa.allscriptsdirect.net

Organizations & group practices 5

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 11

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": "1488153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492646400000",
    "number": "1316487218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S",
            "address_2": "STE 302A",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320803117",
            "telephone_number": "904-461-9330",
            "fax_number": "904-461-9331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S",
            "address_2": "SUITE 302A",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320803108",
            "telephone_number": "904-461-9330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZZINGO",
        "first_name": "JESSE",
        "name_prefix": "Mr.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-27",
        "last_updated": "2017-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9241959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.