Provider Demographics
NPI:1902352388
Name:JAQUES, MELINDA E (AP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:E
Last Name:JAQUES
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 EASTWEST PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-5310
Mailing Address - Country:US
Mailing Address - Phone:904-215-6111
Mailing Address - Fax:904-215-0708
Practice Address - Street 1:1835 EASTWEST PKWY STE 5
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-5310
Practice Address - Country:US
Practice Address - Phone:904-215-6111
Practice Address - Fax:904-215-0708
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist