Maria Anz Jacobs, DNP, FNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

11013916 Issued in FL

Practice address

7730 West Boynton Beach Blvd.
Suite 3
Boynton Beach, FL 33437

Phone

(561) 877-1800

Fax

(561) 742-4480

NPI assigned

Jul 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Dr. Maria Anz Kalick Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Premise Health of Georgia Medical PC

  • Multi-Specialty Clinic/Center
  • Dalton, GA
  • NPI 1588128656
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644883200000",
    "number": "1497780464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7730 WEST BOYNTON BEACH BLVD.",
            "address_2": "SUITE 3",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "33437",
            "telephone_number": "561-877-1800",
            "fax_number": "561-742-4480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7730 WEST BOYNTON BEACH BLVD.",
            "address_2": "SUITE 3",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "33437",
            "telephone_number": "561-877-1800",
            "fax_number": "561-742-4480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "MARIA",
        "middle_name": "ANZ",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "2517262",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN230675",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11013916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2517262",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA STATE LICENSE",
            "identifier": "230675",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "KALICK",
            "middle_name": "ANZ",
            "prefix": "DR.",
            "credential": "DNP, FNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Jacqueline B Pevny
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• Livia Angela Jaen, MD
• Lawrence Eric Jaffe, PT, SCS, ATC

• All providers in Boynton Beach, FL
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.