MR. JACK MELVIN MERWIN (NPI# 1619050473) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619050473 |
| Entity Type | Individual |
| Full Name | MR. JACK MELVIN MERWIN |
| Credential | PSYCHOLOGIST |
| Practice Address |
1100 S Ponce De Leon Blvd Ste 1 Saint Augustine FL 32084-6013 |
| Practice Telephone | 9048247733 |
| Practice Fax Number | 9048299768 |
| Mailing Telephone | 9048247733 |
| Mailing Fax Number | 9048299768 |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
PY2444 | FL | Behavioral Health & Social Service Providers |
| Street Address |
1100 S PONCE DE LEON BLVD STE 1 |
| City | SAINT AUGUSTINE |
| State | FL |
| Zip Code | 32084-6013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104916428 | Stephen William Henneka | Counselor | 1100 S Ponce De Leon Blvd Ste 1, Saint Augustine, FL 32084-6013 | 2006-10-15 |
| 1447333208 | Karen Gail Selig | Counselor | 1100 S Ponce De Leon Blvd Ste 1, Saint Augustine, FL 32084-6013 | 2006-10-23 |
| 1063502383 | Andrew Arnold Sappington IIi | Psychologist | 1100 S Ponce De Leon Blvd Ste 1, Saint Augustine, FL 32084-6013 | 2006-10-15 |
| 1407946726 | David Leroy Hackney | Counselor | 1100 S Ponce De Leon Blvd Ste 1, Saint Augustine, FL 32084-6013 | 2006-10-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295347599 | Cody Martyn | Pharmacist | 955 Fl-16, St. Augustine, FL 32084 | 2020-08-18 |
| 1912562471 | Kjcares Suportive Living Services | Case Manager/Care Coordinator | 20 First Street, Apt 5, St. Augustine, FL 32084 | 2019-05-09 |
| 1558841684 | Kevin D Roberts | Psychologist | 20 First Street Apt 5, St. Augustine, FL 32084 | 2018-08-17 |
| 1568954576 | Gwendolyn Marie Spong | Nurse Practitioner | 2703 N Ponce De Leon Blvd., Minute Clinic #3591, Area 4, Region 46, St. Augustine, FL 32084 | 2018-06-05 |
| 1770940116 | Marian L. Turner-sharpton, Lcsw | Social Worker | 17 Pacific St., Suite 2 (growth Pointe), St. Augustine, FL 32084 | 2016-01-15 |
| 1710358932 | Florida Laboratory Analysis, LLC | Clinical Medical Laboratory | 1690 Us Highway 1 S Ste D, St Augustine, FL 32084 | 2015-10-14 |
| 1780064774 | J Mae Transportation | Non-emergency Medical Transport (VAN) | 28 N Whitney St Apt 404, St Augustine, FL 32084 | 2015-06-04 |
| 1497154520 | Suzanne Smith Weed | Nurse Practitioner | 32 Mulberry Street, Saint Augustine, FL 32084 | 2014-08-14 |
| 1447684469 | Rachel Moran | Counselor | 162 Oneida Street, St. Augustine, FL 32084 | 2013-08-27 |
| 1932545993 | Matrix Medical, LLC | Durable Medical Equipment & Medical Supplies | 56 S Dixie Hwy Ste 1, St Augustine, FL 32084 | 2013-05-17 |
| Find all providers in zip 32084 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
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| 1679108955 | South Florida Senior Center | Psychologist | 2266 Sw 8th St, Miami, FL 33135-4929 | 2020-03-07 |
| 1609407022 | Jaqueline Mola Sanchez | Psychologist | 15141 Sw 144th Ct, Miami, FL 33186-5680 | 2020-02-04 |
| 1780224881 | Linda Bari Wohl | Psychologist | 7412 Riviera Cv, Lakewood Ranch, FL 34202-5044 | 2020-01-07 |
| 1790330504 | Connected Warriors | Psychologist | 950 Communications Ave Suite 115, Boca Raton, FL 33431 | 2019-08-08 |
| 1629620042 | Voyage Behavior Inc | Psychologist | 6411 Roosevelt St, Hollywood, FL 33024-5803 | 2019-07-15 |
| 1558826651 | Militza Saroza | Psychologist | 19901 Nw 67th Circle Ct, Hialeah, FL 33015-2418 | 2019-02-04 |
| 1508368192 | Live Oak Behavioral Health Pa | Psychologist | 341 N Maitland Ave Ste 120, Maitland, FL 32751-4761 | 2018-02-28 |
| 1952800328 | Ah Sunshineenterprises Inc | Psychologist | 6735 Conroy Rd Ste 326, Orlando, FL 32835-3568 | 2018-02-12 |
| Find all providers with the same taxonomy | ||||
| City | SAINT AUGUSTINE |
| Zip Code | 32084 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.