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JACOB THERIAULT DO
NPI 1083416655
Student in an Organized Health Care Education/Training Program in Jacksonville, FL

Active since March 25, 2025PECOS Enrolled
653 W 8TH ST # L18, JACKSONVILLE, FL 32209(904) 244-3094 Get Directions Write a Review

NPPES record last updated: March 25, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jacob Theriault Do NPPES

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

JACOB THERIAULT DO (NPI 1083416655) is an individual student in an organized health care education/training program in Jacksonville, Florida and active in the NPI registry since March 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1083416655
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJACOB THERIAULTCredential: DO
Location Address653 W 8TH ST # L18Jacksonville, FL 32209-6511
Mailing Address653 W 8th St # L18Jacksonville, FL 32209-6511 · (904) 244-3094
Phone(904) 244-3094
Sole ProprietorNo
Enumeration DateMarch 25, 2025
NPPES CertifiedMarch 25, 2025
✔ NPI 1083416655 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

653 W 8TH ST # L18, Jacksonville, FL 32209
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacob Theriault Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

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

TANYA DEOL
Student in an Organized Health Care Education/Training Program
653 W 8TH ST # L18
JACKSONVILLE, FL 32209
Duval County (904) 244-3094
TIANNA SASHER DO
Internal Medicine
653 W 8TH ST # L18
JACKSONVILLE, FL 32209
Duval County (904) 244-3091
MATTHEW MOENCH MD
Psychiatry & Neurology (Neurology)
653 W 8TH ST # L18
JACKSONVILLE, FL 32209
Duval County (727) 217-5609
CHRISTOPHER JAMES MIKULAS
Student in an Organized Health Care Education/Training Program
653 W 8TH ST # L18
JACKSONVILLE, FL 32209
Duval County (904) 244-3094
GABRIEL KAI MORALES DO
Student in an Organized Health Care Education/Training Program
653 W 8TH ST # L18
JACKSONVILLE, FL 32209
Duval County (904) 244-3091
DR. SAMANTHA ISERN MD
Student in an Organized Health Care Education/Training Program
653 W 8TH ST # L18
JACKSONVILLE, FL 32209
Duval County (904) 244-3094
ANVIT DANDU REDDY DO
Student in an Organized Health Care Education/Training Program
653 W 8TH ST # L18
JACKSONVILLE, FL 32209
Duval County (904) 244-3094
LAURA ANABEL OSHEROV DO
Student in an Organized Health Care Education/Training Program
653 W 8TH ST # L18
JACKSONVILLE, FL 32209
Duval County (904) 244-3094

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 Jacob Theriault's NPI number?

The NPI number for Jacob Theriault is 1083416655. It was assigned to this individual provider in the NPPES registry on March 25, 2025.

Where is Jacob Theriault located?

Jacob Theriault practices at 653 W 8th St # L18, Jacksonville, FL 32209. The listed phone number is (904) 244-3094.

What is Jacob Theriault's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jacob Theriault enrolled in Medicare?

Yes. Jacob Theriault is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacob Theriault was last updated on March 25, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.