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General NPI Number Information
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NPI Number | 1700806619
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Entity Type | Individual
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Provider Name | WALDEMAR MELVIN GOULET JR. FNP-BC, NP-C
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 3505 UNIVERSITY BLVD W
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2130
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Country | US
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Telephone | 904-438-7683
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Fax |
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Provider Business Mailing Address
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Address Line | 1722 KINGSWOOD RD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5429
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Country | US
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Telephone | 904-673-2207
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 322401
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9196116
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License Number State | FL
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