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3840 Belfort Rd Ste 302 Jacksonville FL 32216-8210 | |
| (904) 503-3579 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 3840 Belfort Rd Ste 302, Jacksonville, Florida |
| Authorized Official Name and Position | Melissa Titus (PARTNER) |
| Authorized Official Contact | 9045661079 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3840 Belfort Rd Ste 302 Jacksonville FL 32216-8210 Ph: (904) 503-3579 | 3840 Belfort Rd Ste 302 Jacksonville FL 32216-8210 Ph: (904) 503-3579 |
| NPI Number | 1770281495 |
|---|---|
| Provider Enumeration Date | 02/21/2023 |
| Last Update Date | 05/17/2023 |
| Certification Date | 05/17/2023 |
| Medicare PECOS PAC ID | 4688037831 |
|---|---|
| Medicare Enrollment ID | O20230906000503 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770281495 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Melissa Sue Titus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750958138 PECOS PAC ID: 4284024282 Enrollment ID: I20211207000300 |
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