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

Jerry Tavornwattana

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1093177982

Jerry Tavornwattana is an Emergency Medicine in Jacksonville, Florida. Graduated from Wayne State University School of Medicine in 2016, 10 years ago. Practices with Florida Emergency Physicians Kang and Associates MD LLC, a 317-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
10
Trained at
Wayne State University School of Medicine
Licensed in
FL
In the registry since
2016
Specialties on file
2
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Practice location Address checks out

655 W 8th St # C506
Jacksonville, FL 32209-6511
Phone: (904) 244-3817
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence ME140761 (FL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1093177982
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 22, 2016
Last updated in NPPESJune 5, 2019

Medicare enrollment

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

Medicare specialtyEMERGENCY MEDICINE
Medical schoolWAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Graduated 2016 (10 years in practice)
Group practice Florida Emergency Physicians Kang And Associates Md Llc — 317 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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