Magnolia Integrative Wellness & Behavioral Health LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MAGNOLIA INTEGRATIVE WELLNESS & BEHAVIORAL HEALTH LLC

Practice address

4320 Palm St
St Augustine, FL 32084-7303

Phone

(904) 377-1196

NPI assigned

Nov 3, 2023

Organization subpart

No

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

Authorized official

Name

Patricia A Gilliano

Title

Owner

Phone

(904) 377-1196

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1698969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698969600000",
    "number": "1730952581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 PALM ST",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320847303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 PALM ST",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320847303",
            "telephone_number": "904-377-1196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA INTEGRATIVE WELLNESS & BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-03",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A",
        "authorized_official_last_name": "GILLIANO",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-377-1196"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer L Madden, MD
• Thomas Madden, PT, DPT
• Candace M Madick, FNP
• Sherri Lee Maetozo, M.D.
• Eric Joseph Magnifico, DC
• Dipal Mahajan
• Atosa Mahjoory-Khan
• Alicia Mailly, ARNP
• Mainland Physicians Group LLC
• Reina Malcolm

• Psychiatric/Mental Health Nurse Practitioner in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2023; 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.