Provider Demographics
NPI:1780402701
Name:MERIEDY, ANOTTE JUSTILIEN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANOTTE
Middle Name:JUSTILIEN
Last Name:MERIEDY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 TROLLIE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-3833
Mailing Address - Country:US
Mailing Address - Phone:904-866-3702
Mailing Address - Fax:
Practice Address - Street 1:2732 TROLLIE LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3833
Practice Address - Country:US
Practice Address - Phone:907-289-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035357363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health