Active NPI
Gerald Allen Stevens, ATC, LAT
- Athletic Trainer
- Jacksonville, FL
National Provider Identifier
1720069065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL 428
- Practice address
- 11945 San Jose Blvd
Suite 202
Jacksonville, FL 32223-1613 - Phone
- (904) 880-2424
- Fax
- (904) 880-2420
- NPI assigned
- Nov 11, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL 428 | FL | Primary |
Addresses
Primary practice location
11945 San Jose Blvd
Suite 202
Jacksonville, FL 32223-1613
Mailing address
11945 San Jose Blvd
Suite 202
Jacksonville, FL 32223-1613
Phone (904) 880-2424
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AL 428 | Other | FL | STATE LICENSE |
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 |
|---|---|---|---|
| AL 428 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1720069065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11945 SAN JOSE BLVD",
"address_2": "SUITE 202",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322231613",
"telephone_number": "904-880-2424",
"fax_number": "904-880-2420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11945 SAN JOSE BLVD",
"address_2": "SUITE 202",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322231613",
"telephone_number": "904-880-2424",
"fax_number": "904-880-2420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENS",
"first_name": "GERALD",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-11",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL 428",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "AL 428",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}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 Jul 13, 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.