Healthcare Provider Details

I. General information

NPI: 1114831807
Provider Name (Legal Business Name): MARIAH MAI MEINHOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 RAGGEDY POINT RD
FLEMING ISLAND FL
32003-7843
US

IV. Provider business mailing address

4653 RAGGEDY POINT RD
FLEMING ISLAND FL
32003-7843
US

V. Phone/Fax

Practice location:
  • Phone: 816-726-0380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number572423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: