NPIMap

Individual provider Active NPI

Tacha H Souverain, ARNP

  • Family Nurse Practitioner
  • Palm Coast, FL
National Provider Identifier
1518633767
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11014127 Issued in FL
Practice address
84 Pinnacles Dr Ste 200
Palm Coast, FL 32164-2324
Phone
(386) 439-9777
Fax
(386) 439-0800
NPI assigned
Aug 18, 2021
Last updated
Aug 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11014127 FL Primary

Addresses

Primary practice location

84 Pinnacles Dr Ste 200
Palm Coast, FL 32164-2324

Mailing address

84 Pinnacles Dr Ste 200
Palm Coast, FL 32164-2324
Phone (386) 439-9777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221122000230 FL Practitioner - Nurse Practitioner 2163890278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ardent Family Care PAGroup PAC ID 7517933419, 5 clinicians

Practice addresses (Care Compare)

84 Pinnacles Dr
Suite 200
Palm Coast, FL 32164-2324
Phone 3864399777107

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11014127FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ardent Family Care PA CurrentSince Aug 3, 2022 Accepting new patients

Locations

84 Pinnacles Dr
Ste 200
Palm Coast, FL 32164
Phone (386) 439-9777

Interoperability endpoints

  • Direct secure messaging: ardentfamilycare.tachasouverain@159757.advancedmd-direct.com

Organizations & group practices 1

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 8

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": "1629244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1518633767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 PINNACLES DR STE 200",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321642324",
            "telephone_number": "386-439-9777",
            "fax_number": "386-439-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 PINNACLES DR STE 200",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321642324",
            "telephone_number": "386-439-9777",
            "fax_number": "386-439-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUVERAIN",
        "first_name": "TACHA",
        "middle_name": "H",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11014127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

Verify at the official NPI Registry.