Provider Demographics
NPI:1770574865
Name:GOALEN, MELISSA JESSEMAN (ARNP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JESSEMAN
Last Name:GOALEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:JESSEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJAX - DEPT. OF NEPHROLOGY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-383-1013
Practice Address - Fax:904-244-2165
Is Sole Proprietor?:No
Enumeration Date:2005-10-29
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1369112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL500009569OtherRAILROAD MEDICARE
FLY8425OtherBLUECROSS/BLUESHIELD
GA003124170BMedicaid
FL005547400Medicaid
GA003214170AMedicaid
FLY8425OtherBLUECROSS/BLUESHIELD
FLY8425ZMedicare ID - Type Unspecified
GA003124170BMedicaid