Douglas Tackett, AGNP-C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

APRN11018465 Issued in FL

Practice address

801 Medical CT E
Inverness, FL 34452-4623

Phone

(352) 765-3434

NPI assigned

Mar 7, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1646611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1881341253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8853 E HENDERSON TRL",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344508879",
            "telephone_number": "330-322-6856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 MEDICAL CT E",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344524623",
            "telephone_number": "352-765-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-07",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "APRN11018465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Clark Supley
• Falahuddin Syed
• Naeem H Syed, DO
• T&a Transportation
• Jason Ta, DO
• Tampa Bay Dental Sleep Therapy, LLC
• Tara Connor DO PA
• Matthew Vincent Tavares, MD
• TDN Dentistry, PLLC (Gulf Coast Dental Associates)
• Laszlo Bela Teleszky, MD

• Internal Medicine Physician in Inverness, FL
• Providers in Inverness, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.