Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Osullivan, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1649845264

Jack Osullivan, DO is a Family Practice in Jacksonville, Florida. Graduated from Nova Southeastern College of Osteo Medicine in 2021, 5 years ago. Practices with SE Virginia Value Based Care LLC, a 156-clinician group and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
5
Trained at
Nova Southeastern College of Osteo Medicine
Licensed in
VA
In the registry since
2021
Specialties on file
3
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

2080 Child St
Jacksonville, FL 32214-5005
Phone: (902) 542-7300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X · Licence 0102207445 (VA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X
Military Health Care Provider Taxonomy 171000000X

Record details

NPI number1649845264
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedMay 25, 2021
Last updated in NPPESSeptember 22, 2023
Certification dateSeptember 22, 2023
Mailing address2080 Child St, Jacksonville, FL 32214-5005

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolNOVA SOUTHEASTERN COLLEGE OF OSTEO MEDICINE
Graduated 2021 (5 years in practice)
Group practice Se Virginia Value Based Care Llc — 156 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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