Individual provider Active NPI

Emily Anne Archer, APRN

  • Pediatric Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1346973088
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
APRN11020671 Issued in FL
Practice address
858 Monument Rd Ste B
Jacksonville, FL 32225-6670
Phone
(904) 450-8090
NPI assigned
Jul 8, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 11020671 FL
Pediatric Nurse Practitioner 363LP0200X APRN11020671 FL Primary

Addresses

Primary practice location

858 Monument Rd Ste B
Jacksonville, FL 32225-6670

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623
Phone (904) 450-8090

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
I20240604004206 FL Practitioner - Nurse Practitioner 5496297509 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11020671FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc Single Specialty CurrentSince Jun 17, 2024 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Jun 17, 2024 Accepting new patients
Pediatric Associates at Argyle PA Single Specialty PastSince Jul 1, 2022 Accepting new patients
Pediatric Associates at Argyle PA Single Specialty PastSince Aug 27, 2023 Accepting new patients

Locations

858 Monument Rd
Ste B
Jacksonville, FL 32225
Phone (904) 450-8060

10058 Baymeadows Rd
Jacksonville, FL 32256
Phone (904) 450-6870

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

3200 3rd St S
Jacksonville Beach, FL 32250
Phone (904) 450-7050

3200 3rd St S
Ste 101
Jax Bch, FL 32250
Phone (904) 247-4070

Interoperability endpoints

  • Direct secure messaging: emily.archer.1@8967.direct.athenahealth.com

Organizations & group practices 4

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": "1657238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1346973088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-450-8090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "858 MONUMENT RD STE B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322256670",
            "telephone_number": "904-450-8090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARCHER",
        "first_name": "EMILY",
        "middle_name": "ANNE",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-08",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11020671",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "APRN11020671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.