Active NPI
Jerina Jackson
- Clinical Social Worker
- Jacksonville, FL
National Provider Identifier
1952919409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ISW19870
- Practice address
- 1110 Edgewood Ave W
Jacksonville, FL 32208-6405 - Phone
- (904) 448-4700
- NPI assigned
- Jul 21, 2020
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | ISW19870 | FL | Primary |
Addresses
Primary practice location
1110 Edgewood Ave W
Jacksonville, FL 32208-6405
Mailing address
2205 Durham St
Tampa, FL 33605-6135
Phone (813) 507-0580
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 900341538 | Medicaid | FL |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788307200000",
"number": "1952919409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2205 DURHAM ST",
"city": "TAMPA",
"state": "FL",
"postal_code": "336056135",
"telephone_number": "813-507-0580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 EDGEWOOD AVE W",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322086405",
"telephone_number": "904-448-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JERINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-21",
"last_updated": "2026-09-02",
"certification_date": "2026-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "ISW19870",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "900341538",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.