Provider Demographics
NPI:1508259920
Name:NACKASHI, MICHAEL AMER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:AMER
Last Name:NACKASHI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6058 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2358
Mailing Address - Country:US
Mailing Address - Phone:904-379-8094
Mailing Address - Fax:
Practice Address - Street 1:6058 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2358
Practice Address - Country:US
Practice Address - Phone:904-379-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
FLPY11564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No251B00000XAgenciesCase Management