Healthcare Provider Details

I. General information

NPI: 1821531427
Provider Name (Legal Business Name): MELISSA GAGLIARDI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 NIRA ST
JACKSONVILLE FL
32207-8652
US

IV. Provider business mailing address

6022 SAN JOSE BLVD STE 101
JACKSONVILLE FL
32217-2358
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-4991
  • Fax: 904-384-3613
Mailing address:
  • Phone: 904-387-4991
  • Fax: 904-384-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9346980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: