Jackson E. Tillquist, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

ARNP9258226 Issued in FL

Practice address

1840 Mease Dr
Suite 200
Safety Harbor, FL 34695-6602

Phone

(727) 724-8611

Fax

(727) 724-0425

NPI assigned

Apr 13, 2016

Last updated

Oct 14, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baycare Medical Group, Inc.Group PAC ID 6406753623, 1,539 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Morton Plant Hospital Hospital, Clearwater, FL, CCN 100127

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: jackson.tillquist@direct.mybaycare.org

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.

• Baycare Medical Group, Inc.

  • General Practice Physician
  • Clearwater, FL
  • NPI 1043269871

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Baycare Medical Group, Inc

  • Family Medicine Physician
  • Clearwater, FL
  • NPI 1497117329
  NPD
• Baycare Medical Group, Inc.

  • Family Medicine Physician
  • Clearwater, FL
  • NPI 1659720837
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Morton Plant Hospital Association Inc

  dba Morton Plant Hospital

  • General Acute Care Hospital
  • Clearwater, FL
  • NPI 1376529743
  Care Compare affiliation

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476403200000",
    "number": "1720442940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10744",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337578744",
            "telephone_number": "727-532-0002",
            "fax_number": "727-266-4943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 MEASE DR",
            "address_2": "SUITE 200",
            "city": "SAFETY HARBOR",
            "state": "FL",
            "postal_code": "346956602",
            "telephone_number": "727-724-8611",
            "fax_number": "727-724-0425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLQUIST",
        "first_name": "JACKSON",
        "middle_name": "E.",
        "name_prefix": "Mr.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-13",
        "last_updated": "2016-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9258226",
            "primary": true
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "FL",
            "license": "9258226",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018482900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theresa Home Care, Inc.
• Bindu A Thomas, MD
• Shelby D Thompson
• Daniel Lee Thorngren III, M.D.
• Tiffany L. Werhner, Ms, LMHC, PA
• Timothy F. Kelly,M.D., P.a.
• Timothy J Dixon DDS
• Jacqueline C Tinny, ARNP CNM
• Karen Todaro
• Shannon O'Shea Toliver, APRN, MSN, FNP-C

• Nurse Practitioner in Safety Harbor, FL
• Providers in Safety Harbor, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.