DR. KURT ALFRED JAECKLE (NPI# 1205825650) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205825650 |
| Entity Type | Individual |
| Full Name | DR. KURT ALFRED JAECKLE |
| Credential | M.D. |
| Practice Address |
4500 San Pablo Rd S Jacksonville FL 32224 |
| Mailing Address |
4500 San Pablo Rd S Jacksonville FL 32224-1865 |
| Practice Telephone | 9049532000 |
| Practice Fax Number | 9732907495 |
| Mailing Telephone | 9049532000 |
| Mailing Fax Number | 9732907495 |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2020-09-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
25MA09911100 | NJ | Allopathic & Osteopathic Physicians |
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
ME80085 | FL | Allopathic & Osteopathic Physicians |
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
25MA09911100 | NJ | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 99 Beauvoir Ave, Summit, NJ 079013533 | 9739714179 | 9739717905 |
| Street Address |
4500 SAN PABLO RD S |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891799136 | Richard Clarke Agnew | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2005-06-01 |
| 1427657964 | Brianna Iannarelli | Nurse Anesthetist, Certified Registered | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-24 |
| 1538768981 | Heather Anne Dahlen | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-17 |
| 1578161717 | Szilvia Fortner | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-10 |
| 1265049464 | Carolyn Gonzalez | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-09-30 |
| 1467065748 | Ifeloluwa A Olutola | Family Medicine | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-26 |
| 1366055568 | Krina Dipak Vyas | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-26 |
| 1356954911 | Haleigh Diane Shelton | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-24 |
| 1215548805 | Victoria Zeilinger Reams | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-16 |
| 1558971382 | Rachel Marie Hannon | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356974372 | Noelle Parker | Specialist/Technologist | 1 Unf Drivve, Jacksonville, FL 32224 | 2020-02-18 |
| 1124685102 | Charcy Rene Stiller | Specialist/Technologist | 1 Unf Dr., Jacksonville, FL 32224 | 2019-05-24 |
| 1265097513 | Mayo Clinic Jacksonville | Ambulance | 13970 Zumbro Dr, Jacksonville, FL 32224 | 2019-05-02 |
| 1639681471 | Brigantti Anesthesia & Spine Care | Clinic/Center | 1361 13th Ave South Suite #210, Jacksonville, FL 32224 | 2017-11-02 |
| 1093240061 | Beric Emilio Berlioz | Anesthesiology | 4500 San Pablo Rd S # J, Jacksonville, FL 32224 | 2017-04-26 |
| 1609240746 | Matthew James Dailey | Nurse Anesthetist, Certified Registered | 2500 San Pablo Rd S, Jacksonville, FL 32224 | 2015-11-29 |
| 1003299603 | Upscale Personal Care Home | Assisted Living Facility | 4375 Autumn River Road, Jacksonville, FL 32224 | 2015-07-01 |
| 1629459375 | Bellanid Fonseca | Social Worker | 3694 Summerlin Ln E, Jacksonville, FL 32224 | 2015-06-17 |
| 1164840500 | Nicholas Scotto | Physical Therapist | 11555 Central Pkwy Ste 1104, Jacksonville, FL 32224 | 2014-04-02 |
| 1497093454 | Quicker Care Urgent Care | Point of Service | 13770 Beach Blvd., Unit # 4, Jacksonville, FL 32224 | 2013-01-27 |
| Find all providers in zip 32224 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285138495 | Yulia Salamatova | Psychiatry & Neurology | 580 W 8th St # T17, Jacksonville, FL 32209-6533 | 2018-03-21 |
| 1619471018 | William Joseph Scharpf | Psychiatry & Neurology | 653-1 West 8th Street, L18, 4th Floor, Lrc, Jacksonville, FL 32209 | 2018-03-20 |
| 1184155616 | Kyle Wuthrich | Psychiatry & Neurology | 580 W 8th St Fl 9, Jacksonville, FL 32209-6533 | 2017-03-26 |
| 1932511235 | Shannon Laboy | Psychiatry & Neurology | 580 W 8th St # T1-9t17, Jacksonville, FL 32209-6533 | 2014-05-21 |
| 1174933147 | Caitlin E D'souza | Psychiatry & Neurology | 14540 Old Saint Augustine Rd Ste 216, Jacksonville, FL 32258-7418 | 2014-04-30 |
| 1235416322 | Benjamin E Moore Md Pa | Psychiatry & Neurology | 2 Shircliff Way Ste 925, Jacksonville, FL 32204-4711 | 2011-11-03 |
| 1598995599 | Baptist Neurology Inc | Psychiatry & Neurology | 3563 Phillips Hwy Ste 106a, Jacksonville, FL 32207-5663 | 2009-07-24 |
| 1316104722 | Candice Waked Riggeal | Psychiatry & Neurology | 841 Prudential Dr 10th Floor, Jacksonville, FL 32207-8329 | 2008-05-22 |
| 1508089194 | James Gordon Creveling Jr | Psychiatry & Neurology | 7842 Monterey Bay Dr, Jacksonville, FL 32256-2936 | 2007-04-11 |
| 1053471987 | Mark K Emas | Psychiatry & Neurology | 4085 University Blvd South, # 3, Jacksonville, FL 32216 | 2006-12-11 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32224 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.