MR. CHARLES B MADDIX ARNP MSN PMHNP-BC NPI 1790047926

NPI Information

NPI: 1790047926
Provider Name: MR. CHARLES B MADDIX, ARNP, MSN, PMHNP-BC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
2520 UNIVERSITY BLVD W
JACKSONVILLE, FL
ZIP 32217
Phone: (904) 733-1444
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MR. Charles B Maddix, ARNP, MSN, PMHNP-BC is a psychiatric/mental health nurse practitioner in Jacksonville, FL with 24 years of experience. MR. Charles B Maddix, ARNP, MSN, PMHNP-BC NPI is 1790047926. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2520 UNIVERSITY BLVD W
JACKSONVILLE, FL
ZIP 32217-004
Phone: (904) 733-1444
Fax: (904) 733-5258

The NPI 1790047926 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/13/2012 and was last updated on 11/19/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163W00000X	Registered Nurse		9173113	FLORIDA	No
2	2084A0401X	Psychiatry & Neurology	Addiction Medicine	APRN9173113	FLORIDA	No
3	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry	APRN9173113	FLORIDA	No
4	2084P0805X	Psychiatry & Neurology	Geriatric Psychiatry	APRN9173113	FLORIDA	No
5	261QH0100X	Clinic/Center	Health Service	APRN9173113	FLORIDA	No
6	363L00000X	Nurse Practitioner		9173113	FLORIDA	No
7	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	APRN9173113	FLORIDA	Yes
8	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	9173113	FLORIDA	No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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