Theresa M Domagola, ACNP-BC, PMHNP-BC in Jacksonville, FL

Theresa M Domagola, ACNP-BC, PMHNP-BC is a medicare enrolled "Nurse Practitioner - Acute Care" in Jacksonville, Florida. She went to University Of Rochester School Of Medicine And Dentistry and graduated in 2003 and has 21 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice University Of Florida Jacksonville Physicians, Inc. and her current practice location is 15255 Max Leggett Pkwy Ste 3600, Jacksonville, Florida. You can reach out to her office (for appointments etc.) via phone at (904) 427-6895.

Theresa M Domagola is licensed to practice in Florida (license number 11002747) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1184676322.

Contact Information

	Theresa M Domagola, ACNP-BC, PMHNP-BC
	15255 Max Leggett Pkwy Ste 3600, Jacksonville, FL 32218-7279
	(904) 427-6895
	Not Available

Map and Direction

Provider's Profile

Full Name	Theresa M Domagola
Gender	Female
Speciality	Nurse Practitioner
Experience	21 Years
Location	15255 Max Leggett Pkwy Ste 3600, Jacksonville, Florida
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Theresa M Domagola attended and graduated from University Of Rochester School Of Medicine And Dentistry in 2003

NPI Data:

NPI Number: 1184676322
Provider Enumeration Date: 05/16/2006
Last Update Date: 06/24/2024

Medicare PECOS Information:

PECOS PAC ID: 0840234050
Enrollment ID: I20191227001192

Medical Identifiers

Medical identifiers for Theresa M Domagola such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1184676322	NPI	-	NPPES
70008ARA6884	Other		MCR
02601196	Medicaid	NY

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LA2100X	Nurse Practitioner - Acute Care	430210 (New York)	Secondary
363LA2100X	Nurse Practitioner - Acute Care	11002747 (Florida)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Shands Jacksonville	Jacksonville, FL	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
University Of Florida Jacksonville Physicians, Inc.	9133025869	665

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Theresa M Domagola allows following entities to bill medicare on her behalf.

Entity Name	University Of Florida Jacksonville Physicians, Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1144276452 PECOS PAC ID: 9133025869 Enrollment ID: O20040128000786

Entity Name	Pinecrest Medical Specialists Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1952076713 PECOS PAC ID: 0446657134 Enrollment ID: O20211015002209

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Theresa M Domagola is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Theresa M Domagola, ACNP-BC, PMHNP-BC 15255 Max Leggett Pkwy Ste 3600, Jacksonville, FL 32218-7279 Ph: (904) 427-6895	Theresa M Domagola, ACNP-BC, PMHNP-BC 15255 Max Leggett Pkwy Ste 3600, Jacksonville, FL 32218-7279 Ph: (904) 427-6895

Reviews and Comments

Nurse Practitioner Nurses in Jacksonville, FL

Mrs. Rhode L. Jean-aleger, ARNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 10075 Gate Pkwy N Apt 102, Jacksonville, FL 32246 Phone: 904-997-9844 Fax: 904-997-9844
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Shannon Kathleen Burns, ARNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 4500 San Pablo Rd S, Jacksonville, FL 32224 Phone: 904-953-2000
Christy Mcewen, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 836 Prudential Dr Ste 1700b, Unit 1, Jacksonville, FL 32207 Phone: 904-398-0125 Fax: 904-389-1832
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Theresa M Domagola, ACNP-BC, PMHNP-BC - Medicare Nurse Practitioner in Jacksonville, FL