Stacie Jackson, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9115246 Issued in FL

Practice address

3627 University Blvd S Ste 550
Jacksonville, FL 32216-7401

Phone

(904) 379-5986

NPI assigned

Nov 4, 2021

Last updated

Mar 10, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Physician Assistant

Education

Nova Southeastern College of Osteo Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hughston Clinic Southeast PCGroup PAC ID 9234423971, 48 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Orange Park Hospital Hospital, Orange Park, FL, CCN 100226

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stacie.jackson.1@321.direct.athenahealth.com

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.

• Hughston Clinic Southeast PC

  • Orthopaedic Surgery Physician
  • Columbus, GA
  • NPI 1225401946

  FL

  Medicare reassignment Care Compare group NPD
• Hughston Clinic Southeast PC

  • Durable Medical Equipment & Medical Supplies
  • Nashville, TN
  • NPI 1770004863
  NPD

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

• Orange Park Medical Center, Inc.

  dba HCA Florida Orange Park Hospital

  • General Acute Care Hospital
  • Orange Park, FL
  • NPI 1689611501
  Care Compare affiliation

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

{
    "created_epoch": "1635984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1770248668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "FORTSON",
            "state": "GA",
            "postal_code": "318080370",
            "telephone_number": "706-494-3171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3627 UNIVERSITY BLVD S STE 550",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322167401",
            "telephone_number": "904-379-5986"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5540 NE 4th St",
            "address_purpose": "LOCATION",
            "city": "Ocala",
            "state": "FL",
            "postal_code": "344709512",
            "country_code": "US",
            "telephone_number": "352-547-0878",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STACIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-04",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9115246",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9115246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samia Jackson, B.S.
• Sarah Michelle Jackson, PHARM.D.
• Saundra Alicia Jackson, MD
• Shakiera N Jackson
• Shontae D Jackson
• Steven Marc Jackson, PT
• Sydney Jackson
• Sylvia H Jackson, PHARMD
• Tameatrice Michelle Jackson, RN/CRT
• Tasheka B Jackson

• Surgical Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; 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.