MEDICARE: MELINDA E JAQUES A.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
1	171100000X	Acupuncturist	AP 3758	FL

General Provider Information

NPI Number	:	1902352388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA E JAQUES A.P.

Provider Business Mailing Address
First Line	:	1835 EASTWEST PKWY STE 5
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-5310
Country	:	US
Telephone Number	:	904-215-6111
Fax Number	:	904-215-0708

Provider Business Practice Location Address
First Line	:	1835 EASTWEST PKWY STE 5
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-5310
Country	:	US
Telephone Number	:	904-215-6111
Fax Number	:	904-215-0708

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

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/26/2016

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