Organization Active NPI

Dream Primary Care LLC

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1659168516
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DREAM PRIMARY CARE LLC
Doing business as
Dream Primary Care
Practice address
2255 Dunn Ave Ste 503
Jacksonville, FL 32218-4742
Phone
(904) 521-7564
NPI assigned
Apr 23, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Authorized official

Name
Tatianna Miles
Title
Credentialing Specialist
Phone
(904) 868-8923

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

2255 Dunn Ave Ste 503
Jacksonville, FL 32218-4742

Mailing address

2255 Dunn Ave Ste 503
Jacksonville, FL 32218-4742
Phone (904) 521-7564

Other names 1

  • Dream Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250609001948 FL Part B Supplier - Clinic/Group Practice 4082124136 Receives reassigned benefits from 1 practitioner
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory

Locations

2255 Dunn Ave
Ste 503
Jacksonville, FL 32218
Phone (904) 521-7564

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1745366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1659168516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 DUNN AVE STE 503",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184742",
            "telephone_number": "904-521-7564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 DUNN AVE STE 503",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184742",
            "telephone_number": "904-521-7564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DREAM PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-23",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A",
        "authorized_official_last_name": "MILES",
        "authorized_official_first_name": "TATIANNA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "904-868-8923"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dream Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.