Individual provider Active NPI

Jessica Lee Moore, APRN

  • Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1972167450
Registry record updated Apr 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11002259 Issued in FL
Practice address
3900 University Blvd S
Jacksonville, FL 32216-4331
Phone
(904) 222-6656
NPI assigned
Apr 30, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11002259 FL Primary

Addresses

Primary practice location

3900 University Blvd S
Jacksonville, FL 32216-4331

Mailing address

1415 1St St N Apt 1001
Jacksonville Beach, FL 32250-8309
Phone (904) 899-2349

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
I20231117001316 FL Practitioner - Nurse Practitioner 4587011267 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11002259FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ashchi Heart & Vascular Center PA CurrentSince Nov 1, 2023 Accepting new patients
Bagnoli and Salah Partnership PastSince Nov 1, 2023 Accepting new patients

Locations

3900 University Blvd S
Jacksonville, FL 32216
Phone (904) 222-6656

3900 University Blvd S
Ste A
Jacksonville, FL 32216
Phone (904) 222-6656

Interoperability endpoints

  • Direct secure messaging: jessicamoore@ahvcpa.allscriptsdirect.net

Organizations & group practices 2

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": "1556582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556582400000",
    "number": "1972167450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 1ST ST N APT 1001",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322508309",
            "telephone_number": "904-899-2349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164331",
            "telephone_number": "904-222-6656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JESSICA",
        "middle_name": "LEE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-30",
        "last_updated": "2019-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11002259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.