Northeast Florida Area Agency on Aging

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

NORTHEAST FLORIDA AREA AGENCY ON AGING

Doing business as

Eldersource

Practice address

10688 Old Saint Augustine Rd
Jacksonville, FL 32257-1004

Phone

(904) 391-6600

Fax

(904) 391-6601

NPI assigned

Jun 23, 2016

Last updated

Jun 23, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jalynne Santiago

Title

Director of Finance

Phone

(904) 391-6627

Specialties & licenses 1

Addresses

Other names 1

• Eldersource Doing business as

Locations

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466640000000",
    "number": "1902257785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10688 OLD SAINT AUGUSTINE RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322571004",
            "telephone_number": "904-391-6600",
            "fax_number": "904-391-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10688 OLD SAINT AUGUSTINE RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322571004",
            "telephone_number": "904-391-6600",
            "fax_number": "904-391-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST FLORIDA AREA AGENCY ON AGING",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-23",
        "last_updated": "2016-06-23",
        "status": "A",
        "authorized_official_last_name": "SANTIAGO",
        "authorized_official_first_name": "JALYNNE",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "904-391-6627"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eldersource",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Northeast Florida Endocrine & Diabetes Associates, PA
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• Early Intervention Provider Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Early Intervention Provider Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.