Active NPI
Brent Vincent Fragola, DC
- Chiropractor
- Jacksonville, FL
National Provider Identifier
1407420367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 13292
- Practice address
- 4413 Town Center Pkwy Ste 205
Jacksonville, FL 32246-8570 - Phone
- (904) 221-7799
- NPI assigned
- May 16, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 13292 | FL | Primary |
Addresses
Primary practice location
4413 Town Center Pkwy Ste 205
Jacksonville, FL 32246-8570
Mailing address
3701 Danforth Dr Apt 1503
Jacksonville, FL 32224-5231
Phone (862) 354-1780
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 |
|---|---|---|---|
| 13292 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621123200000",
"number": "1407420367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3701 DANFORTH DR APT 1503",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322245231",
"telephone_number": "862-354-1780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4413 TOWN CENTER PKWY STE 205",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322468570",
"telephone_number": "904-221-7799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRAGOLA",
"first_name": "BRENT",
"middle_name": "VINCENT",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-16",
"last_updated": "2021-05-16",
"certification_date": "2021-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "13292",
"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 May 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.