Individual provider Active NPI

Laurie Ann Iliff, APRN

  • Family Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1720958580
Registry record updated Dec 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11042395 Issued in FL
Practice address
12574 Flagler Center Blve Ste. 201
Jacksonville, FL 32258
Phone
(913) 634-9598
NPI assigned
Nov 7, 2025
Last updated
Dec 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11042395 FL Primary

Addresses

Primary practice location

12574 Flagler Center Blve Ste. 201
Jacksonville, FL 32258

Mailing address

12574 Flagler Center Blve Ste. 201
Jacksonville, FL 32258
Phone (913) 634-9598

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
I20260106002528 FL Practitioner - Nurse Practitioner 9830685239 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Georgetown University School of Medicine, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Florida Surgeons PAGroup PAC ID 2769381391, 336 clinicians

Practice addresses (Care Compare)

14546 Old Saint Augustine Rd
Suite 401
Jacksonville, FL 32258-5473
Phone (904) 268-5366

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11042395FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Florida Surgeons, PA CurrentSince Nov 1, 2025 Accepting new patients
North Florida Surgeons, PA CurrentSince Nov 1, 2025 Accepting new patients

Locations

36468 Emerald Coast Pkwy
Ste 1101
Destin, FL 32541
Phone (850) 290-2154

1340 S 18th St
Ste 104
Fernandina Beach, FL 32034
Phone (904) 277-3277

14546 Old St Augustine Rd
Ste 401
Jacksonville, FL 32258
Phone (904) 268-5366

12574 Flagler Center Blvd
Ste 201
Jacksonville, FL 32258
Phone (904) 268-5366

11945 San Jose Blvd
Ste 102
Jacksonville, FL 32223
Phone (904) 268-3937

Interoperability endpoints

  • Direct secure messaging: laurie.iliff.1@9109.direct.athenahealth.com

Organizations & group practices 2

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 1

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": "1762473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766966400000",
    "number": "1720958580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12574 FLAGLER CENTER BLVE STE. 201",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32258",
            "telephone_number": "913-634-9598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12574 FLAGLER CENTER BLVE STE. 201",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32258",
            "telephone_number": "913-634-9598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILIFF",
        "first_name": "LAURIE",
        "middle_name": "ANN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-11-07",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11042395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.