Individual provider Active NPI

Anna Ruth-Mildred New

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1831613165
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9110750 Issued in FL
Practice address
3625 University Blvd S
Jacksonville, FL 32216-4222
Phone
(904) 702-6089
NPI assigned
Jul 28, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9110750 FL Primary

Addresses

Primary practice location

3625 University Blvd S
Jacksonville, FL 32216-4222

Mailing address

3625 University Blvd S
Jacksonville, FL 32216-4207
Phone (904) 702-6089

Other practice location 1

11850 Atlantic Blvd
Jacksonville, FL 32225-2918
Phone (904) 998-5001

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
I20180308000674 FL Practitioner - Physician Assistant 3779844741 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9110750FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Inpatient Consultants of Florida, Inc Physician Assistant CurrentSince Mar 1, 2021 Accepting new patients
Kindred Hospitals East, LLC CurrentSince Dec 31, 2025 Accepting new patients
Black Bag Medical Inc CurrentSince Dec 31, 2025 Accepting new patients

Locations

4320 Deerwood Lake Pkwy
Jacksonville, FL 32216
Phone (904) 620-0599

3840 Belfort Rd
Ste 102
Jacksonville, FL 32216
Phone (904) 371-4051

3625 University Blvd S
Jacksonville, FL 32216
Phone (904) 333-9404

6000 49th St N
St Petersburg, FL 33709
Phone (727) 521-4411

3030 W Bearss Ave
Tampa, FL 33618
Phone (813) 932-2222

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1831613165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164207",
            "telephone_number": "904-702-6089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164222",
            "telephone_number": "904-702-6089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11850 Atlantic Blvd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322252918",
            "country_code": "US",
            "telephone_number": "904-998-5001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEW",
        "first_name": "ANNA",
        "middle_name": "RUTH-MILDRED",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-28",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9110750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.