Organization
MIELKE GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEANNINE B. MIELKE PH.D. (OWNER)
(904) 607-2079
Entity
Organization
Contact information
Practice address
3 SHIRCLIFF WAY, SUITE #333, JACKSONVILLE, FL 32204-4757
(904) 607-2079
(904) 384-0094
Mailing address
7177 AUGUSTA DR, FLEMING ISLAND, FL 32003-8755
(904) 607-2079
(904) 384-0094
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY6839
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74187
BLUE CROSS AND BLUE SHIELD OF FLORIDA
FL
Enumeration date
11/14/2008
Last updated
08/17/2009
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