Individual provider Active NPI

Jessica Dare Evans

  • Family Nurse Practitioner
  • Palatka, FL
National Provider Identifier
1861817413
Registry record updated Feb 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9212876 Issued in FL
Practice address
611 Zeagler Dr
Palatka, FL 32177-3810
Phone
(386) 328-5711
NPI assigned
Feb 19, 2014
Last updated
Feb 19, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2014

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 9212876 FL Primary

Addresses

Primary practice location

611 Zeagler Dr
Palatka, FL 32177-3810

Mailing address

611 Zeagler Dr
Palatka, FL 32177-3810
Phone (386) 328-5711

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
I20140925000394 FL Practitioner - Nurse Practitioner 9739309733 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Paragon Emergency Services LLCGroup PAC ID 8628153087, 401 clinicians

Practice addresses (Care Compare)

611 Zeagler Dr
Palatka, FL 32177-3810
Phone (800) 424-3672

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9212876FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Paragon Emergency Services LLC CurrentSince Jan 1, 2016 Accepting new patients

Locations

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

611 Zeagler Dr
Palatka, FL 32177
Phone (386) 326-8070

1451 El Camino Real
The Villages, FL 32159
Phone (352) 751-8000

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1392768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392768000000",
    "number": "1861817413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 ZEAGLER DR",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321773810",
            "telephone_number": "386-328-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 ZEAGLER DR",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321773810",
            "telephone_number": "386-328-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "JESSICA",
        "middle_name": "DARE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-19",
        "last_updated": "2014-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9212876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palatka, FL

Sources for this page

Verify at the official NPI Registry.