NPIMap

Individual provider Active NPI

Tara Renee Blackshear

  • Family Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1881199396
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9342671 Issued in FL
Practice address
655 W 8TH St
Jacksonville, FL 32209-6511
Phone
(904) 244-7118
NPI assigned
Mar 27, 2018
Last updated
Apr 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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 9342671 FL Primary

Addresses

Primary practice location

655 W 8TH St
Jacksonville, FL 32209-6511

Mailing address

450077 State Road 200 Ste 12
Callahan, FL 32011-3863
Phone (904) 633-0560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180531002699 FL Practitioner - Nurse Practitioner 7214292895 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Florida Jacksonville Physicians, Inc.Group PAC ID 9133025869, shared by 5 NPIs, 908 clinicians

Practice addresses (Care Compare)

450077 State Rd
Suite 12
Callahan, FL 32011-3863
Phone (904) 633-0560

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
59.59 of 100Reported as apm
Quality
59.93
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9342671FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians Inc CurrentSince Apr 23, 2018 Accepting new patients
University of Florida Jacksonville Physicians Inc Current Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Apr 23, 2018 Accepting new patients
University of Florida Jacksonville Physicians Inc Current Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Apr 23, 2018 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Past Accepting new patients

Locations

450077 State Road 200
Ste 12
Callahan, FL 32011
Phone (904) 633-0560

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

Interoperability endpoints

  • Direct secure messaging: tblackshear331538@direct.shands.ufl.edu

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1881199396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450077 STATE ROAD 200 STE 12",
            "city": "CALLAHAN",
            "state": "FL",
            "postal_code": "320113863",
            "telephone_number": "904-633-0560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-244-7118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKSHEAR",
        "first_name": "TARA",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-27",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9342671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.