MEDICARE: MARANDA NICOLE MASSEY FNP-BC,PMHNP-BC,APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11020330	FL
2	163WE0003X	Emergency Registered Nurse	9218621	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11020330	FL

General Provider Information

NPI Number	:	1346426764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARANDA NICOLE MASSEY FNP-BC,PMHNP-BC,APRN

Provider Business Mailing Address
First Line	:	2389 COUNTRY SIDE DR
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4907
Country	:	US
Telephone Number	:	850-603-0771
Fax Number	:	820-228-0720

Provider Business Practice Location Address
First Line	:	6488 103RD ST STE A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7161
Country	:	US
Telephone Number	:	904-450-6815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	05/28/2026

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