Jeannine Boyle Mielke, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PY0006839 Issued in FL

Practice address

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

Phone

(904) 607-2079

Fax

(904) 384-0094

NPI assigned

Jan 5, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Jeannine Marie Boyle Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217548800000",
    "number": "1831246131",
    "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": "904-529-7441",
            "fax_number": "904-529-7440"
        },
        {
            "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": {
        "last_name": "MIELKE",
        "first_name": "JEANNINE",
        "middle_name": "BOYLE",
        "name_prefix": "Mrs.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2008-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY0006839",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSF",
            "identifier": "74187",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANNINE",
            "last_name": "BOYLE",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Midtown Dental of Jacksonville
• Midwife Hope Terrell LLC
• Emmanuel T. Miel Jr., MD
• Mielke Group, Inc.
• Catherine Mielke, APRN, CNS
• Louis Edward Miers, PA
• Samuel W. Mietling, M.D.
• Christina L. Migliara, LMFT, MAC, CAP
• Joseph Mignone, MD
• Dennis P Mihale, MD

• 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 1, 2008; 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.