MEDICARE: MS. MAYUKO MONDESTIN

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	363LF0000X	Family Nurse Practitioner	11040568	FL

General Provider Information

NPI Number	:	1518841212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAYUKO MONDESTIN

Provider Business Mailing Address
First Line	:	1731 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8928
Country	:	US
Telephone Number	:	904-725-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	9889 GATE PKWY N BLDG 200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-9228
Country	:	US
Telephone Number	:	904-725-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	05/18/2026

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