MEDICARE: ANOTTE JUSTILIEN MERIEDY 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	APRN11035357	FL

General Provider Information

NPI Number	:	1780402701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANOTTE JUSTILIEN MERIEDY PMHNP-BC

Provider Business Mailing Address
First Line	:	2732 TROLLIE LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-3833
Country	:	US
Telephone Number	:	904-866-3702
Fax Number	:

Provider Business Practice Location Address
First Line	:	2732 TROLLIE LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-3833
Country	:	US
Telephone Number	:	907-289-1254
Fax Number	:

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

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	01/07/2025

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