1437109063 NPI number — MRS. MELISSA GRIFFIN TYLER APRN

Table of content: MRS. MELISSA GRIFFIN TYLER APRN (NPI 1437109063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437109063 NPI number — MRS. MELISSA GRIFFIN TYLER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYLER
Provider First Name:
MELISSA
Provider Middle Name:
GRIFFIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIFFIN
Provider Other First Name:
MELISSA
Provider Other Middle Name:
GAIL
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437109063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 44047
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32231-4047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-376-4083
Provider Business Mailing Address Fax Number:
904-391-5075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
836 PRUDENTIAL DR STE 802
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-8335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-202-8290
Provider Business Practice Location Address Fax Number:
904-202-8171
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  ARNP9164462 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0200X , with the licence number: ARNP 21264 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 012959500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003151292A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012959500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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