Individual provider Active NPI

Ian Neilh Floresca

  • Other Specialist/Technologist
  • Jacksonville, FL
National Provider Identifier
1366249765
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Other Specialist/TechnologistTaxonomy code 246Z00000X
Practice address
2080 Child St FL 32214
Jacksonville, FL 32214-5005
Phone
(904) 542-9438
NPI assigned
Feb 25, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Other Specialist/Technologist 246Z00000X Primary

Addresses

Primary practice location

2080 Child St FL 32214
Jacksonville, FL 32214-5005

Mailing address

10809 Avenues Walk Blvd
Jacksonville, FL 32258-1758
Phone (571) 572-8611

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

NPI Registry JSON

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

{
    "created_epoch": "1740441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740441600000",
    "number": "1366249765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10809 AVENUES WALK BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322581758",
            "telephone_number": "571-572-8611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST FL 32214",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322145005",
            "telephone_number": "904-542-9438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLORESCA",
        "first_name": "IAN",
        "middle_name": "NEILH",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-02-25",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.