Healthcare Provider Details

I. General information

NPI: 1770574865
Provider Name (Legal Business Name): MELISSA JESSEMAN GOALEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN JESSEMAN ARNP

II. Dates (important events)

Enumeration Date: 10/29/2005
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST UFJAX - DEPT. OF NEPHROLOGY
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

PO BOX 44008 UFJP - PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1013
  • Fax: 904-244-2165
Mailing address:
  • Phone: 904-244-3199
  • Fax: 904-244-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1369112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: