Justin E. Pickens, APRN
Individual provider Active NPI Nurse Practitioner · Port Charlotte, FL
NPI 1790371995 · NPPES record last updated Apr 30, 2025
Key facts
- NPI
- 1790371995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 11010438 (FL)
- Practice address
- 4235 Kings Highway
Suite 103
Port Charlotte, FL 33980-8421 - Phone
- (941) 613-1777
- Fax
- (941) 613-1779
- NPI assigned
- Dec 12, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mori Bean and Brooks Inc
Pulmonary Sleep and Critical Care Specialists PL
Practice addresses (Care Compare)
2001 Kingsley Ave
Orange Park, FL 32073-5148
Phone (904) 399-5550
21298 Olean Blvd
Port Charlotte, FL 33952-6705
Phone (904) 399-5550
4235 Kings Hwy
Unit 103
Port Charlotte, FL 33980-8421
Phone (941) 613-1777
509 39TH Ave N
St Petersburg, FL 33703-6103
Phone (904) 399-5550
Hospital & facility affiliations
- HCA Florida Fawcett Hospital
- HCA Florida North Florida Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.83 of 100
- Quality
- 84.01
- Improvement activities
- 40
- Cost
- 74.09
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210405000571 | FL | Practitioner - Nurse Practitioner | 6608283999 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11010438 | FL | MD | Acute Care Nurse Practitioner |
Practice roles (2 of 4)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pulmonary Practice Associates MD PA | Current |
Accepting new patients | |
| Nautilus Health Care Group LLC | Nurse Practitioner | Past |
Accepting new patients |
Locations
749 Stirling Center Pl
Lake Mary, FL 32746
Phone (407) 321-8230
749 Stirling Center Pl
Bldg 8
Lake Mary, FL 32746
Phone (407) 321-8230
1075 Town Center Dr
Orange City, FL 32763
Phone (386) 917-0333
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Interoperability endpoints
- justin.pickens@hca5.eclinicaldirectplus.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- justin.pickens.p1@direct.ppafl.nextgenshare.com
- justin.pickens.1@2765.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 11010438 | FL | |
| Nurse Practitioner | 363L00000X | 11010438 | FL | Yes |
Addresses
Primary practice location
4235 Kings Highway
Suite 103
Port Charlotte, FL 33980-8421
Mailing address
4235 Kings Highway
Suite 103
Port Charlotte, FL 33980-8421
Phone (941) 613-1777
Other providers in Port Charlotte, FL
- Thresia Phillips
- Phyamerica Hospital Specialists LLC
- Phyllis Baird Adult Family Care Home
- Physician Extenders PA
- Physiotherapy Associates, Inc.
- Maryanna Piekarski
- Marcia Pierre
- Annalise Pietro
- William James Pillar Jr.
- Scott C Piller
All providers in Port Charlotte, FL · Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.