BRENT S MICKLEY
Physician Assistant

Address: 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616

BRENT S MICKLEY (NPI# 1124034269) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1124034269
Entity Type Individual
Full Name MR. BRENT S MICKLEY
Gender Male
Credential PA
Practice Address 14534 Old Saint Augustine Rd Ste 3420
Jacksonville
FL 32258-2616
Practice Telephone 9044938001
Practice Fax Number 9043380852
Mailing Address Po Box 43667
Jacksonville
FL 32203-3667
Mailing Telephone 9047200599
Mailing Fax Number 9043764036
Certification Date 2020-03-31
Enumeration Date 2006-07-31
Last Update Date 2020-03-31
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification Taxonomy Group License Number License State Grouping
Y 363A00000X Physician Assistant PA9103362 FL Physician Assistants & Advanced Practice Nursing Providers
N 363A00000X Physician Assistant 0010-05496 NC Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifiers

Identifier State Issuer Type Code
018231000 FL MEDICAID
P01718560 FL RR MEDICARE Other

Physician Overview

PECOS Associate Control (PAC) ID 1254364300
by Medicare Provider Enrollment and Chain/Ownership System (PECOS)
Professional Enrollment ID I20050919000196
Last Name MICKLEY
First Name BRENT
Middle Name S
Credential PA
Organization Legal Name BAPTIST CARDIOLOGY, INC.
Location 836 Prudential Dr, Suite 1700, Jacksonville, FL 32207-8344
Phone Number 9043980125
Graduation Year 2005
Primary Specialty PHYSICIAN ASSISTANT
Group Practice PAC ID 2466614581
Number of Group Practice Members 60

Office Location

Street Address 14534 OLD SAINT AUGUSTINE RD STE 3420
City JACKSONVILLE
State FL
Zip Code 32258-2616

Providers in the same location

NPI Name Taxonomy Address Enumeration
1396718359 Ashwini K Davuluri Internal Medicine - Cardiovascular Disease 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 2006-02-09
1033141692 Bharat Kumar Gummadi Internal Medicine - Cardiovascular Disease 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 2006-07-06
1831462829 Baptist Cardiology, Inc. · Baptist Heart Specialists Internal Medicine - Cardiovascular Disease 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 2012-02-22
1356654339 Emiliana Franco Ladron De Guevara Internal Medicine - Cardiovascular Disease 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 2010-07-20
1225000748 Arashk Motiei Internal Medicine - Cardiovascular Disease 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2645 2006-02-07
1851318828 Bonnie Jean Gandee Physician Assistant - Medical 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 2006-07-16
1588214845 Katrina Romanow Nurse Practitioner 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 2019-09-18
1437150349 Praveen Kanaparti Internal Medicine - Cardiovascular Disease 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 2005-08-02
1144286212 David J Stroh Internal Medicine - Cardiovascular Disease 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2616 2006-04-26
1730499062 Wagma Qazizada Physician Assistant 14534 Old Saint Augustine Rd Ste 3420, Jacksonville, FL 32258-2645 2010-10-20
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1740230168 Richard L Snyder Orthopaedic Surgery 14534 Old Saint Augustine Rd Ste 3210, Jacksonville, FL 32258-2616 2006-05-10
1699910950 Aaron Martin Chiropractor 14534 Old Saint Augustine Rd Ste 3210, Jacksonville, FL 32258-2616 2008-12-15

Providers in the same zip code prefix

NPI Name Taxonomy Address Enumeration
1184057978 Lindsay M Fleetwood Physical Therapist 14985 Old Saint Augustine Rd Unit 106, Credentialing Department, Jacksonville, FL 32258 2013-08-15
1023104536 Igor Melnychuk Internal Medicine 14546 Old St Augustine Rd, Suite 107, Jacksonville, FL 32258 2006-10-04
1578622908 Jason Lee Dentist - Oral and Maxillofacial Surgery 13820 Old St Augustine Rd, Suite 105, Jacksonville, FL 32258 2006-12-08
1669708608 Sleep Ez of Jacksonville Inc. Physiological Laboratory 6735 Greenland Industrial Blvd., Bldg 100, Jacksonville, FL 32258 2009-10-27
1699979005 Beverly Bass · Beverly Flood Occupational Therapist 6100 Bartram Village Drive, Jacksonville, FL 32258 2007-06-12
1902048598 Shannon Page Goossen Acupuncturist 14546 Old St Augustine Road, Suite 403, Jacksonville, FL 32258 2009-03-30
1326595927 Lauren Cost Chiropractor 14866 Old St. Augustine Road, Suite 113, Jacksonville, FL 32258 2016-09-01
1215189790 Jennifer Faye Mazyck-Brown Pharmacist 14335 Millhopper Road, Jacksonville, FL 32258 2008-10-16
1487991170 Mark Steven Colosimo Pharmacist 13820 Old St Augustine Road, Jacksonville, FL 32258 2013-01-15
1679092886 Palm Life Medical Associates Pa Assisted Living Facility 12494 Acosta Oaks Drive, Jacksonville, FL 32258 2017-09-19
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Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1760064240 Andrew John Cassaniti Physician Assistant 8649 A C Skinner Pkwy Apt 128, Jacksonville, FL 32256-7871 2021-04-25
1700466406 Chandler Nicole Kehoe Physician Assistant 3627 University Blvd S Ste 430, Jacksonville, FL 32216-4299 2021-04-08
1235728015 Madalyn Ingmire Physician Assistant 6675 Corporate Center Pkwy Ste 115, Jacksonville, FL 32216-8088 2021-01-15
1013505940 Lisa Fellis Physician Assistant 6484 Fort Caroline Rd, Jacksonville, FL 32277-2042 2021-01-06
1013505189 Nishtha Garg Physician Assistant 7857 Blackstone River Dr E, Jacksonville, FL 32256-2993 2021-01-05
1538765524 Lillian Michaela Kronz Physician Assistant 312 Providence Dr, Jacksonville, NC 28546-6112 2020-12-07
1831799527 Emily Vander Zee Physician Assistant 6680 Bennett Creek Dr Apt 213, Jacksonville, FL 32216-0018 2020-10-30
1245830314 Jonathan V Korah Physician Assistant 6650 Corporate Center Pkwy Apt 1108, Jacksonville, FL 32216-8725 2020-10-28
1255931473 Rachel Gavrielle Rivera Physician Assistant 11438 Emuness Rd, Jacksonville, FL 32218-4050 2020-10-27
1760099071 Laura Alexandra Ramos-Heckman Physician Assistant 2014 Capistrano Dr, Jacksonville, FL 32224-3091 2020-09-30
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City JACKSONVILLE
Zip Code 32258

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Dataset Information

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.

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