Individual provider Active NPI

Jency Nahomy Polanco, APRN

  • Pediatrics Physician
  • St Augustine, FL
National Provider Identifier
1700528056
Registry record updated Apr 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
APRN11018207 Issued in FL
Practice address
3504 Kings Rd S
St Augustine, FL 32086-5079
Phone
(786) 295-9090
NPI assigned
Apr 8, 2022
Last updated
Apr 15, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X APRN11018207 FL Primary

Addresses

Primary practice location

3504 Kings Rd S
St Augustine, FL 32086-5079

Mailing address

3504 Kings Rd S
St Augustine, FL 32086-5079
Phone (786) 295-9090

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
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11018207FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saltzman, Tanis, Pittell, Levin and Jacobson, LLC Pediatrics CurrentSince Feb 1, 2024 Accepting new patients
Angel Kids PA Past Accepting new patients
East Pompano Pediatrics Corp Pediatrics PastSince Apr 10, 2022 Accepting new patients

Locations

601 E Sample Rd
Ste 107
Deerfield Beach, FL 33064
Phone (954) 210-7016

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9792/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1649376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776211200000",
    "number": "1700528056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3504 KINGS RD S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865079",
            "telephone_number": "786-295-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3504 KINGS RD S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865079",
            "telephone_number": "786-295-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLANCO",
        "first_name": "JENCY",
        "middle_name": "NAHOMY",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-08",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "APRN11018207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.