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General NPI Number Information
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NPI Number | 1790615813
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Entity Type | Organization
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Legal Business Name | BAY HARBOR HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 05/20/2026
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Last Update Date | 05/20/2026
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Provider Practice Location Address
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Address Line | 12627 SAN JOSE BLVD STE 204
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8638
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Country | US
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Telephone | 423-715-8037
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Fax |
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Provider Business Mailing Address
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Address Line | 101 PARADISE VALLEY DR
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City | PONTE VEDRA
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State | FL
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Zip | 32081-6123
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Country | US
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Telephone | 423-715-8037
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MEREDITH BRAINARD
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Credential | ARNP
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Telephone | 423-715-8037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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