MEDICARE: JACQUELYN MENNINGA PMHNP-BC

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	APRN11044947	FL

General Provider Information

NPI Number	:	1730970526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN MENNINGA PMHNP-BC

Provider Business Mailing Address
First Line	:	4300 MARSH LANDING BLVD STE 101
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-1419
Country	:	US
Telephone Number	:	904-686-8055
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 MARSH LANDING BLVD
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-1416
Country	:	US
Telephone Number	:	904-686-8055
Fax Number	:

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

Provider Enumeration Date	:	05/13/2025
Last Update Date	:	02/13/2026

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