Mielke Group, Inc.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PY6839 Issued in FL

Legal business name

MIELKE GROUP, INC.

Practice address

3 Shircliff Way
Suite #333
Jacksonville, FL 32204-4757

Phone

(904) 607-2079

Fax

(904) 384-0094

NPI assigned

Nov 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeannine B. Mielke, PH.D.

Title

Owner

Phone

(904) 607-2079

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250467200000",
    "number": "1013161223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7177 AUGUSTA DR",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320038755",
            "telephone_number": "904-607-2079",
            "fax_number": "904-384-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 SHIRCLIFF WAY",
            "address_2": "SUITE #333",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044757",
            "telephone_number": "904-607-2079",
            "fax_number": "904-384-0094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIELKE GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-14",
        "last_updated": "2009-08-17",
        "status": "A",
        "authorized_official_last_name": "MIELKE",
        "authorized_official_first_name": "JEANNINE",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-607-2079",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY6839",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD OF FLORIDA",
            "identifier": "74187",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trina Middleton
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• Midtown Dental of Jacksonville
• Midwife Hope Terrell LLC
• Emmanuel T. Miel Jr., MD
• Catherine Mielke, APRN, CNS
• Jeannine Boyle Mielke, PHD
• Louis Edward Miers, PA
• Samuel W. Mietling, M.D.
• Christina L. Migliara, LMFT, MAC, CAP

• Clinical Neuropsychologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Neuropsychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.