MEDICARE: ALISON ELIZABETH MCCANN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN11039254	FL

General Provider Information

NPI Number	:	1407646920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON ELIZABETH MCCANN

Provider Business Mailing Address
First Line	:	2465 US 1 S
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-6076
Country	:	US
Telephone Number	:	904-239-9996
Fax Number	:

Provider Business Practice Location Address
First Line	:	2465 US 1 S
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-6076
Country	:	US
Telephone Number	:	904-239-9996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	05/08/2025

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