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Renard Agbontaen

Physician β€’ Jacksonville, FL

Deactivated NPI 1134544414 Deactivated in NPPES Male Practitioner
Practice location in NPPES

6175 Bassanova Ct
Jacksonville, FL 322091813

Phone: 9045549637

Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

This NPI Is Deactivated in NPPES

NPPES lists this NPI as deactivated as of November 06, 2020; the reason is not published. The records below are historical. They do not show whether Renard Agbontaen currently practices or holds a license; check the state medical board for current license status.

NPI Enumeration Date February 24, 2014
NPI Deactivation Date November 06, 2020
NPI Active Period 2014 – 2020

Practice Location & Contact Primary Location

Practice Address

6175 Bassanova Ct

Jacksonville, FL 322091813

Telephone 9045549637

NPI first issued

2014

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Compared with the same specialty in Jacksonville and Florida

Comparisons are not shown because NPPES lists this NPI as deactivated.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Home Health Primary Specialty

NUCC Taxonomy Code: 251E00000X

A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Florida Department of Health Medical Quality Assurance.
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Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

7 Historical Events
⚠️
NPI Profile Deactivated November 06, 2020

NPPES lists this NPI as deactivated as of November 06, 2020; the reason is not published.

βœ…
NPI Profile Active February 24, 2014

NPI status registered as active in NPPES database

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Practice Location (Initial Record) February 24, 2014

Registered at 6175 BASSANOVA CT, JACKSONVILLE, FL 322091813 (Tel: 9045549637)

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Business Mailing Address (Initial Record) February 24, 2014

Registered at 6175 BASSANOVA CT, JACKSONVILLE, FL 322091813 (Tel: 9045549637)

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Provider Name / Credentials (Initial Record) February 24, 2014

Recorded as RENARD AGBONTAEN

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 24, 2014

Home Health

🟒
Initial NPI Registration & Enumeration February 24, 2014

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1134544414
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 24, 2014
Last Update: February 24, 2014
Deactivation Date: November 06, 2020

Mailing Address

6175 Bassanova Ct

Jacksonville, FL 322091813

Phone: 9045549637

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.