Bliss Carley Tkaczyk, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9112344 Issued in FL

Practice address

841 Prudential Dr
Jacksonville, FL 32207-8329

Phone

(904) 396-5682

NPI assigned

Jun 14, 2011

Last updated

Feb 2, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, FL2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Emergency Medicine Professionals PA

  • Emergency Medicine Physician
  • Deland, FL
  • NPI 1205880853
  Medicare reassignment NPD
• North Shore-Lij Medical PC

  dba NHPP Cardiology at Great Neck

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment NPD
• Emergency Physicians Inc

  dba Emergency Resources Group

  • Emergency Medicine Physician
  • Jacksonville, FL
  • NPI 1285686675
  Medicare reassignment
• Metropolitan Medical Practice Plan PC

  • General Practice Physician
  • New York, NY
  • NPI 1306138383
  Medicare reassignment

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

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1588959902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 PETER ISLAND DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320927429",
            "telephone_number": "917-602-7402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 PRUDENTIAL DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078329",
            "telephone_number": "904-396-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TKACZYK",
        "first_name": "BLISS",
        "middle_name": "CARLEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-14",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014870-1",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel S Tismal, MD
• Lacey Titkemeier, PT, LAT, ATC
• Melissa Sue Titus, RN
• Renee Cherie Titus
• Eric James Tizzard, MD
• TLCC Enterprises LLC (Home Helpers)
• TLM Counseling
• TNT Industry LLC
• Tntmd PA
• Ana Bolena Tobar Hicks, MD

• 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 Feb 2, 2024; 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.