Active NPI
Casey Nietz, APRN
- Family Nurse Practitioner
- Saint Johns, FL
National Provider Identifier
1922739358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 11020289
- Practice address
- 170 Fountains Way Ste 6
St Johns, FL 32259-1173 - Phone
- (904) 382-6589
- NPI assigned
- Jun 17, 2022
- Last updated
- Feb 2, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 11020289 | FL | Primary |
Addresses
Primary practice location
170 Fountains Way Ste 6
St Johns, FL 32259-1173
Mailing address
4846 Parkhurst PL
Jacksonville, FL 32256-6046
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11020289 | FL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706832000000",
"number": "1922739358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4846 PARKHURST PL",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322566046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "170 FOUNTAINS WAY STE 6",
"city": "ST JOHNS",
"state": "FL",
"postal_code": "322591173",
"telephone_number": "904-382-6589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIETZ",
"first_name": "CASEY",
"name_prefix": "Mrs.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-17",
"last_updated": "2024-02-02",
"certification_date": "2024-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "FL",
"license": "11020289",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Johns, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.