Individual provider Active NPI

Emily Jackson

  • Psychiatric/Mental Health Nurse Practitioner
  • Gulf Breeze, FL
National Provider Identifier
1881552628
Registry record updated Jan 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
11044846 Issued in FL
Practice address
3146 Cornell Dr
Gulf Breeze, FL 32563-2794
Phone
(850) 543-8865
NPI assigned
Jan 12, 2026
Sex
Unspecified or another gender identity
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 11044846 FL Primary

Addresses

Primary practice location

3146 Cornell Dr
Gulf Breeze, FL 32563-2794

Mailing address

3146 Cornell Dr
Gulf Breeze, FL 32563-2794

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
I20260318002100 FL Practitioner - Nurse Practitioner 4284118233 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Balanced Wellbeing LLCGroup PAC ID 5193021848, 228 clinicians

Practice addresses (Care Compare)

3200 SW 34TH Ave
Suite 701
Ocala, FL 34474-8443
Phone (877) 779-2429

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11044846FLMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Balanced Wellbeing LLC CurrentSince Feb 9, 2026 Accepting new patients

Locations

3200 SW 34th Ave
Ste 701
Ocala, FL 34474
Phone (354) 445-1200

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1768176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768176000000",
    "number": "1881552628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3146 CORNELL DR",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325632794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3146 CORNELL DR",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325632794",
            "telephone_number": "850-543-8865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EMILY",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2026-01-12",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11044846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulf Breeze, FL

Sources for this page

Verify at the official NPI Registry.