Healthcare Provider Details

I. General information

NPI: 1093357204
Provider Name (Legal Business Name): MELISSA O'QUIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-2790
US

IV. Provider business mailing address

PO BOX 311
PONTE VEDRA BEACH FL
32004-0311
US

V. Phone/Fax

Practice location:
  • Phone: 904-553-1017
  • Fax: 904-328-6100
Mailing address:
  • Phone: 904-553-1017
  • Fax: 904-328-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: