MEDICARE: KATIE MEGHAN FOSS PA-C

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	363A00000X	Physician Assistant	PA9120228	FL

General Provider Information

NPI Number	:	1932099561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE MEGHAN FOSS PA-C

Provider Business Mailing Address
First Line	:	5901 E FOWLER AVE STE 100
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-2305
Country	:	US
Telephone Number	:	813-978-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	10503 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6295
Country	:	US
Telephone Number	:	990-445-0667
Fax Number	:

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

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	02/02/2026

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