Organization
MAGNOLIA INTEGRATIVE WELLNESS & BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA A GILLIANO (OWNER)
(904) 377-1196
Entity
Organization
Contact information
Practice address
4320 PALM ST, ST AUGUSTINE, FL 32084-7303
(904) 377-1196
Mailing address
4320 PALM ST, ST AUGUSTINE, FL 32084-7303
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/03/2023
Last updated
11/03/2023
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