Provider Demographics
NPI:1548545361
Name:GOLMAYO, MYRAGRACE JAPITANA (ARNP)
Entity type:Individual
Prefix:MS
First Name:MYRAGRACE
Middle Name:JAPITANA
Last Name:GOLMAYO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 A C SKINNER PARKWAY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-493-3333
Mailing Address - Fax:904-493-2222
Practice Address - Street 1:665 STATE ROAD 207
Practice Address - Street 2:SUITE 102
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-5938
Practice Address - Country:US
Practice Address - Phone:904-824-8158
Practice Address - Fax:904-823-1284
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3016172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014241600Medicaid
FLFV174YMedicare PIN