MEDICARE: MRS. MELISSA JANE BOYLE APRN

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	163W00000X	Registered Nurse	RN9320462	FL
2	225700000X	Massage Therapist	MA35203	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11007220	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770718678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA JANE BOYLE APRN

Provider Business Mailing Address
First Line	:	3948 3RD ST S STE 151
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5847
Country	:	US
Telephone Number	:	619-641-9776
Fax Number	:

Provider Business Practice Location Address
First Line	:	12058 SAN JOSE BLVD STE 1003
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8667
Country	:	US
Telephone Number	:	904-391-9875
Fax Number	:	904-321-9890

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	10/26/2021

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