Individual provider Active NPI

Rachael Morrow Shad, APRN

  • Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1639966245
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11038289 Issued in FL
Practice address
1632 Edgewood Ave S
Jacksonville, FL 32205-8410
Phone
(904) 476-8320
NPI assigned
Apr 24, 2025
Last updated
Apr 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11038289 FL Primary

Addresses

Primary practice location

1632 Edgewood Ave S
Jacksonville, FL 32205-8410

Mailing address

1632 Edgewood Ave S
Jacksonville, FL 32205-8410
Phone (904) 476-8320

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250507002892 FL Practitioner - Nurse Practitioner 9335666973 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Primary Care Solutions Jacksonville LLCGroup PAC ID 9739553207, 13 clinicians

Practice addresses (Care Compare)

42 Davin CT
Ponte Vedra Beach, FL 32082-1840
Phone (904) 490-0264

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11038289FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Solutions Jacksonville LLC CurrentSince Feb 28, 2025 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1745452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1639966245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1632 EDGEWOOD AVE S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322058410",
            "telephone_number": "904-476-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1632 EDGEWOOD AVE S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322058410",
            "telephone_number": "904-476-8320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAD",
        "first_name": "RACHAEL",
        "middle_name": "MORROW",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-24",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11038289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.