MEDICARE: MRS. MERNAMIE CASTARDO TAMAN ARNP/NURSE PRACTITIO

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	363LA2200X	Adult Health Nurse Practitioner	AP124079	TX
2	363LF0000X	Family Nurse Practitioner	11023649	FL
3	363LA2200X	Adult Health Nurse Practitioner	APRN11023649	FL

General Provider Information

NPI Number	:	1710968912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MERNAMIE CASTARDO TAMAN ARNP/NURSE PRACTITIO

Provider Business Mailing Address
First Line	:	115 LATERRA LINKS CIR UNIT 101
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3526
Country	:	US
Telephone Number	:	909-200-9014
Fax Number	:

Provider Business Practice Location Address
First Line	:	9310 OLD KINGS RD S STE 1303
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8100
Country	:	US
Telephone Number	:	904-900-3472
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	11/21/2025

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