Carmen Renee Jackson, ARNP, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

ARNP935595 Issued in FL

Practice address

1005 N Lake Parker Ave
Lakeland, FL 33805-4723

Phone

(863) 583-4053

NPI assigned

Jan 31, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Monogram Health Professional Services of Florida LLCGroup PAC ID 0244608149, 41 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Clinch Memorial Hospital Hospital, Homerville, GA, CCN 111308

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: carmen.jackson.1@22854.direct.athenahealth.com

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.

• Monogram Health Professional Services of Florida LLC

  • Nephrology Physician
  • Jacksonville, FL
  • NPI 1538883111

  Family

  Medicare reassignment Care Compare group NPD
• Millennium Physician Group LLC

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1811122880
  NPD (past)

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

• Clinch County Hospital Authority

  • Critical Access Hospital
  • Homerville, GA
  • NPI 1861478851
  Care Compare affiliation

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

{
    "created_epoch": "1517356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520294400000",
    "number": "1346748688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 EUCLID AVE APT 4B",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331396526",
            "telephone_number": "305-726-4727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 N LAKE PARKER AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338054723",
            "telephone_number": "863-583-4053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CARMEN",
        "middle_name": "RENEE",
        "name_prefix": "Miss",
        "credential": "ARNP, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-31",
        "last_updated": "2018-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP935595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivonne Izaguirre
• Sonia Izquierdo
• Izsak & Lamport,MD,PA
• J & a Therapy, Inc
• J Roger Demonsthenes
• Charlie Jackson, RMHCI
• Gina M Jackson, PTA
• Joy Jackson
• Joy Lynn Jackson, M.D.
• Lindsey R Jackson

• Family Nurse Practitioner in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.