| Doctor Name: | DR. JACQUES HOWARD AMOLE |
| NPI Number: | 1861529505 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DNP, APRN |
| License Number: | 1084092 |
| Business Practice Address: | 200 San Sebastian Way St. Augustine, FL - 32084 |
| Business Phone Number: | 9042096234 |
| Business Fax Number: | |
| Mailing Address: | 1220 Willis Ave, DAYTONA BEACH |
| State: | FL |
| Postal Code: | 321142810 |
| Phone Number: | 3862363200 |
| Fax Number: | |
| NPI Enumeration Date: | 02/28/2007 |
| NPI Last Update Date: | 05/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 1084092 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |