Active NPI
Jennifer Renee Carlisle, PTA
- Physical Therapy Assistant
- Amelia Island, FL
National Provider Identifier
1376786335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA20378
- Practice address
- 76 Osprey Village Dr
Amelia Island, FL 32034-4962 - Phone
- (904) 491-1701
- Fax
- (904) 491-1702
- NPI assigned
- Apr 7, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA20378 | FL | Primary |
Addresses
Primary practice location
76 Osprey Village Dr
Amelia Island, FL 32034-4962
Mailing address
76 Osprey Village Dr
Amelia Island, FL 32034
Phone (904) 491-1701
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA20378 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239062400000",
"number": "1376786335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 OSPREY VILLAGE DR",
"city": "AMELIA ISLAND",
"state": "FL",
"postal_code": "32034",
"telephone_number": "904-491-1701",
"fax_number": "904-491-1702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "76 OSPREY VILLAGE DR",
"city": "AMELIA ISLAND",
"state": "FL",
"postal_code": "320344962",
"telephone_number": "904-491-1701",
"fax_number": "904-491-1702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLISLE",
"first_name": "JENNIFER",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-07",
"last_updated": "2009-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA20378",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amelia Island, FL
- 8 Flags Chiropractic
- Amelia Island Plastic Surgery LLC
- James Antun, DC
- Amaris Avellan, PH.D.
- Shelley Hicks Botts, CCC/SLP
- CMZ Chiropractic LLC
- Family Counseling & Psychological Services LLC
- Genesis Eldercare Rehabilitation Services LLC
- Genesis Eldercare Rehabilitation Services LLC
- Jayde Marie Gray, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.