Healthcare Provider Details

I. General information

NPI: 1437080322
Provider Name (Legal Business Name): JACQUELYN ELIZABETH ANTAL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 OCEAN AVE
MELBOURNE BEACH FL
32951-2572
US

IV. Provider business mailing address

321 OCEAN AVE STE 213
MELBOURNE BEACH FL
32951-2569
US

V. Phone/Fax

Practice location:
  • Phone: 321-328-7026
  • Fax: 321-233-0320
Mailing address:
  • Phone: 321-328-7026
  • Fax: 321-233-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberRN9607217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: