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NPI Code Detail

MEDICARE: SJOUKJE ODETTE MOONEYHAM C.N.M./A.R.N.P.

MEDICARE: SJOUKJE ODETTE MOONEYHAM C.N.M./A.R.N.P.
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
1367A00000XAdvanced Practice MidwifeARNP3408202FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881636553
Entity Type Code : Individual
Provider Name (Legal Business Name) : SJOUKJE ODETTE MOONEYHAM C.N.M./A.R.N.P.
Provider Business Mailing Address
First Line : 4425 MERRIMAC AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-1850
Country : US
Telephone Number : 904-346-0050
Fax Number : 904-346-0080
Provider Business Practice Location Address
First Line : 4425 MERRIMAC AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-1850
Country : US
Telephone Number : 904-346-0050
Fax Number : 904-346-0080
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 12/09/2020

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