Jacksonville Psych, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

JACKSONVILLE PSYCH, LLC

Practice address

12058 San Jose Blvd.
Suite 404-C
Jacksonville, FL 32223-8666

Phone

(904) 708-9220

NPI assigned

Dec 6, 2021

Organization subpart

No

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

Authorized official

Name

Ms. Jessica Gregory, APRN

Title

Aprn, Owner

Phone

(904) 330-4059

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1638748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638748800000",
    "number": "1477211506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12058 SAN JOSE BLVD.",
            "address_2": "SUITE 404-C",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238666",
            "telephone_number": "904-708-9220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12058 SAN JOSE BLVD.",
            "address_2": "SUITE 404-C",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238666",
            "telephone_number": "904-708-9220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE PSYCH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-06",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "APRN, OWNER",
        "authorized_official_telephone_number": "904-330-4059",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacksonville Pediatrics
• Jacksonville Physical Medicine LLC
• Jacksonville Plastic Surgery Inc
• Jacksonville Premier Orthopedics LLC
• Jacksonville Primary Care PA
• Jacksonville Psychiatric Association Inc
• Jacksonville Psychiatric Services
• Jacksonville Psychiatry and Wellness LLC
• Jacksonville Radiation Therapy Services LLC
• Jacksonville Radiology Associates PA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.

Verify at the official NPI Registry.