Individual provider Active NPI

Jillian Jacques

  • Certified Registered Nurse Anesthetist
  • Boca Raton, FL
National Provider Identifier
1518595248
Registry record updated Mar 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APRN11019742 Issued in FL
Practice address
2057 Park PL
Boca Raton, FL 33486-3117
Phone
(561) 716-4090
NPI assigned
Mar 30, 2020
Last updated
Mar 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X APRN11019742 FL Primary

Addresses

Primary practice location

2057 Park PL
Boca Raton, FL 33486-3117

Mailing address

2057 Park PL
Boca Raton, FL 33486-3117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220826002032 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 3870977739 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sheridan Healthcorp IncGroup PAC ID 3173429693, 956 clinicians

Practice addresses (Care Compare)

1309 N Flagler Dr
West Palm BCH, FL 33401-3406
Phone (561) 650-6271

1801 W Sample Rd
Suite 102
Deerfield Beach, FL 33064-1370
Phone (954) 939-5000

401 NW 42ND Ave
Plantation, FL 33317-2835
Phone (954) 587-5010

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
APRN11019742FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered CurrentSince Aug 15, 2022 Accepting new patients
Sheridan Healthcorp, Inc. CurrentSince Aug 15, 2022 Accepting new patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
St. Lucie Anesthesia Associates, LLC CurrentSince Aug 1, 2023 Accepting new patients
St Lucie Anesthesia Associates LLC Current Accepting new patients
St. Lucie Anesthesia Associates, LLC CurrentSince Aug 1, 2023 Accepting new patients

Locations

1801 W Sample Rd
Ste 102
Deerfield Beach, FL 33064
Phone (754) 212-3248

4675 Linton Blvd
Delray Beach, FL 33445
Phone (561) 381-4305

3995 NW Goldenrod Rd
Jensen Beach, FL 34957
Phone (772) 497-0020

401 NW 42nd Ave
Plantation, FL 33317
Phone (954) 513-6434

1800 SE Tiffany Ave
Port St Lucie, FL 34952
Phone (772) 398-1969

1613 NW 136th Ave
Ste 200
Sunrise, FL 33323
Phone (954) 838-2502

Organizations & group practices 6

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710028800000",
    "number": "1518595248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2057 PARK PL",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334863117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2057 PARK PL",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334863117",
            "telephone_number": "561-716-4090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "JILLIAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-30",
        "last_updated": "2024-03-10",
        "certification_date": "2024-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "APRN11019742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.