Healthcare Provider Details

I. General information

NPI: 1174062962
Provider Name (Legal Business Name): GINA-MARIE NOLAN MALEJKO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 13TH AVE S STE 270
JACKSONVILLE BEACH FL
32250-3258
US

IV. Provider business mailing address

PO BOX 748519
ATLANTA GA
30374-8519
US

V. Phone/Fax

Practice location:
  • Phone: 904-376-3800
  • Fax:
Mailing address:
  • Phone: 904-376-3800
  • Fax: 904-396-8971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9364192
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9364192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: