Joni Collins Ricketts, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9103731 Issued in FL

Practice address

10210 San Jose Blvd Ste 4
Jacksonville, FL 32257-6271

Phone

(904) 990-8484

Fax

(904) 990-8485

NPI assigned

Jul 18, 2006

Last updated

Nov 27, 2019By the provider in NPPES

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

Other identifiers 4

Other names 1

• Joni Nicole Collins Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Physician Group Holdings, LLC

  dba Ageless Vein Center

  • Vascular & Interventional Radiology Physician
  • Jacksonville, FL
  • NPI 1003478827
  NPD
• Symphony Specialty Group, LLC

  • Specialist
  • Jacksonville, FL
  • NPI 1831878735
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574812800000",
    "number": "1437178928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10210 SAN JOSE BLVD STE 4",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322576271",
            "telephone_number": "904-990-8484",
            "fax_number": "904-990-8485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10210 SAN JOSE BLVD STE 4",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322576271",
            "telephone_number": "904-990-8484",
            "fax_number": "904-990-8485"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10210 San Jose Blvd Ste 4",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322576271",
            "country_code": "US",
            "telephone_number": "904-990-8484",
            "fax_number": "904-990-8485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICKETTS",
        "first_name": "JONI",
        "middle_name": "COLLINS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2019-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - INDIVIDUAL",
            "identifier": "FH506W",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL PA LICENSE",
            "identifier": "PA9103731",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003872-00",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0038372-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JONI",
            "last_name": "COLLINS",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Malissa Ann Richter, APRN
• Sandra S Richter, MD
• Arthur C Ricker Jr., APRN
• Morgan Rose Rickett, OTR/L
• Jeffrey D Ricketts, PA
• Tatianna Ricketts, BA
• Kimberly Ann Rickey, P.T.
• Imani Ricks
• Megan Ricks, WHNP-BC
• Irene Kanaris Rickus

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2019; 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.