Jaclyn Planz

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

12276 San Jose Blvd Ste 508
Jacksonville, FL 32223-8618

Phone

(904) 886-3228

Fax

(904) 485-8876

NPI assigned

Apr 21, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Samuels Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1912394669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75149 BROOKWOOD DR",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "320971620",
            "telephone_number": "904-923-1781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12276 SAN JOSE BLVD STE 508",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238618",
            "telephone_number": "904-886-3228",
            "fax_number": "904-485-8876"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Gatz Rd",
            "address_purpose": "LOCATION",
            "city": "Riverhead",
            "state": "NY",
            "postal_code": "119012362",
            "country_code": "US",
            "telephone_number": "631-605-9957",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PLANZ",
        "first_name": "JACLYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-21",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "SAMUELS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Planned Parenthood of Northeast Florida, Inc
• Planned Parenthood of Northeast Florida, Inc
• Planned Parenthood of Northeast Florida, Inc.
• Reshena Plant
• Marie Morrison Plante, MD
• Jennifer Elizabeth Plappert, PA-C
• Plateau Group LLC (Marvallous Nurse Registry)
• Marinelle Platon-Jones, DO
• Kaelicia Platt
• Rachel Platt, MS, CCC-SLP

• Behavior Technician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; 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.