Active NPI
Jackie Willson
- Registered Nurse
- Pensacola, FL
National Provider Identifier
1619393410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 299994180
- Practice address
- 4400 Bayou Blvd Ste 39B
Pensacola, FL 32503-1911 - Phone
- (850) 478-9701
- Fax
- (850) 478-9750
- NPI assigned
- Mar 17, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 299994180 | FL | Primary |
Addresses
Primary practice location
4400 Bayou Blvd Ste 39B
Pensacola, FL 32503-1911
Mailing address
4400 Bayou Blvd Ste 39B
Pensacola, FL 32503-1911
Phone (850) 478-9701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 299994180 | FL | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Concura Inc. | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395014400000",
"number": "1619393410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4400 BAYOU BLVD STE 39B",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325031911",
"telephone_number": "850-478-9701",
"fax_number": "850-478-9750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4400 BAYOU BLVD STE 39B",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325031911",
"telephone_number": "850-478-9701",
"fax_number": "850-478-9750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLSON",
"first_name": "JACKIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-17",
"last_updated": "2014-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "FL",
"license": "299994180",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pensacola, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.