Unknown Individual – Physician Assistant, NPI 1023239928

Unknown Individual is a healthcare provider. based in Jacksonville, Florida. specializing in Physician Assistant. They hold a License No. PA3124 (FL). The NPI Number for Unknown Individual is 1023239928

Main info

Organization
Inactive
33 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1023239928
Phone
(904) 389-5333
Address
2 SHIRCLIFF WAY
Deactivation Date
1 September 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9043895333
Graduation Year
1993 (33 years ago)
PAC ID
2062583347
Group Practice PAC ID
9032011663
Professional Enrollment ID
I20080613000071
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 2 SHIRCLIFF WAY

    SUITE 700 DEPAUL BLDG.

    JACKSONVILLE, FL 322044763

    Phone: (904) 389-5333

    Fax: (904) 389-5332

    Type: Mailing

  • 1563 KINGSLEY AVENUE

    SUITE 106

    ORANGE PARK, FL 32073

    Phone: (904) 272-6161

    Fax: (904) 389-5332

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32204)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9032011663View full group profile
NameSpecialtyState
N E P H R O L O G YFL
N E P H R O L O G YFL
Nurse PractitionerFL
Nurse PractitionerFL
Nephrology, HospitalistFL
N E P H R O L O G YFL
Nephrology, Internal MedicineFL
N E P H R O L O G YFL
N E P H R O L O G YFL
N E P H R O L O G YNC

Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1023239928.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Physician Assistant. Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Jacksonville, Florida as the reference point for Unknown Individual, then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.