Active NPI
Laura B Nilsen, EDS
- School Psychologist
- Jacksonville, FL
National Provider Identifier
1871930230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- SS848
- Practice address
- 4745 Sutton Park CT
Suite 802
Jacksonville, FL 32224-0250 - Phone
- (904) 476-5916
- NPI assigned
- May 25, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | SS848 | FL | Primary |
Addresses
Primary practice location
4745 Sutton Park CT
Suite 802
Jacksonville, FL 32224-0250
Mailing address
2172 Brighton Bay TRL W
Jacksonville, FL 32246-7205
Phone (904) 476-5916
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SS848 | FL | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369440000000",
"number": "1871930230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2172 BRIGHTON BAY TRL W",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322467205",
"telephone_number": "904-476-5916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4745 SUTTON PARK CT",
"address_2": "SUITE 802",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322240250",
"telephone_number": "904-476-5916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NILSEN",
"first_name": "LAURA",
"middle_name": "B",
"name_prefix": "Mrs.",
"credential": "EDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-25",
"last_updated": "2013-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "FL",
"license": "SS848",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.