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JACKSONVILLE PEDIATRICS
NPI 1043346745
Pediatrics - Adolescent Medicine in Jacksonville, FL

Active since February 26, 2007CLIA Certified · 2 labs
2606 PARK ST, JACKSONVILLE, FL 32204(904) 388-4646(904) 388-9071 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 21, 2022, Aug 22, 2020 (2 updates tracked since 2020).

About Jacksonville Pediatrics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSONVILLE PEDIATRICS (NPI 1043346745) is a healthcare organization registered as an adolescent medicine in Jacksonville, Florida and active in the NPI registry since February 2007. The organization holds 2 active CLIA laboratory certificates and lists Randolph Edens Thornton, Senior Physician, as its authorized official.

NPPES Registry Identity

NPI1043346745
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameJACKSONVILLE PEDIATRICS
Location Address2606 PARK STJacksonville, FL 32204-4520
Mailing Address2606 Park StJacksonville, FL 32204-4520 · (904) 388-4646 · Fax (904) 388-9071
Phone(904) 388-4646
Fax(904) 388-9071
Organization SubpartNo
Authorized OfficialRandolph Edens ThorntonSenior Physician · (904) 389-4140
Enumeration DateFebruary 26, 2007
Last NPPES UpdateJuly 21, 20222 updates tracked since enumeration
✔ NPI 1043346745 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
Definition
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
2606 PARK ST, Jacksonville, FL 32204
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AvMed.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D0701294

Jacksonville Pediatrics · Jacksonville, FL
Active · expires Jul 13, 2028
CLIA Number10D0701294
Laboratory TypePhysician Office
Certificate Effective DateJuly 14, 2026
Certificate Expiration DateJuly 13, 2028
Laboratory DirectorRandolph E. Thornton
Laboratory Phone(904) 388-4646
Laboratory LocationJacksonville Pediatrics2606 Park Street, Jacksonville, FL 32204
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2324391

Jacksonville Pediatrics World Golf Village PLLC · Saint Augustine, FL
Active · expires May 21, 2027
CLIA Number10D2324391
Laboratory TypePhysician Office
Certificate Effective DateMay 22, 2025
Certificate Expiration DateMay 21, 2027
Laboratory DirectorRyan C. Cantville
Laboratory Phone(904) 388-4646
Laboratory LocationJacksonville Pediatrics World Golf Village PLLC130 Land Grant St, Suite 3, Saint Augustine, FL 32092
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. KERRY LYNN NOLAN APRN
Nurse Practitioner (Pediatrics)
2606 PARK ST
JACKSONVILLE, FL 32204
Duval County (904) 388-4606
ELIZABETH FAITH EMERSON PNP-PC
Nurse Practitioner (Pediatrics)
2606 PARK ST
JACKSONVILLE, FL 32204
Duval County (904) 388-4646
NAN S MCCLELLAND M.D.
Pediatrics
2606 PARK ST
JACKSONVILLE, FL 32204
Duval County (904) 388-4646
RYAN CANTVILLE D.O.
Pediatrics
2606 PARK ST
JACKSONVILLE, FL 32204
Duval County (904) 388-4646
MRS. MARY E LOTT M.D.
Pediatrics
2606 PARK ST
JACKSONVILLE, FL 32204
Duval County (904) 388-4646
CEARA DREXEL NP
Nurse Practitioner
2606 PARK ST
JACKSONVILLE, FL 32204
Duval County (904) 388-4646
MR. RANDOLPH E THORNTON M. D.
Pediatrics
2606 PARK ST
JACKSONVILLE, FL 32204
Duval County (904) 388-4646
MRS. CATHLEEN HELENA SOUTHALL ARNP
Nurse Practitioner (Pediatrics)
2606 PARK ST
JACKSONVILLE, FL 32204
Duval County (904) 388-4646

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacksonville Pediatrics's NPI number?

The NPI number for Jacksonville Pediatrics is 1043346745. It was assigned to this organization in the NPPES registry on February 26, 2007.

Where is Jacksonville Pediatrics located?

Jacksonville Pediatrics is located at 2606 Park St, Jacksonville, FL 32204. The listed phone number is (904) 388-4646.

What is Jacksonville Pediatrics's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Does Jacksonville Pediatrics hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Jacksonville Pediatrics accept?

Health plans from AvMed list Jacksonville Pediatrics as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jacksonville Pediatrics was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.