MEDICARE: FLOURISH MENTAL HEALTH AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1053274670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOURISH MENTAL HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	76020 WILLIAM BURGESS BLVD UNIT 5
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-5490
Country	:	US
Telephone Number	:	904-849-0889
Fax Number	:	904-849-0898

Provider Business Practice Location Address
First Line	:	1890 S 14TH ST BUILDING 100 STE 110
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034
Country	:	US
Telephone Number	:	904-849-0889
Fax Number	:	904-849-0898

Authorized Official
Title or Position	:	PRESIDENT, OWNER
Name	:	MALIA AMBER WEBER-PARKER
Credential	:	PMHNP-BC, FNP-C
Telephone Number	:	413-205-7405

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	04/07/2026

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