MEDICARE: TAUSHA CHARAE MCCLAIN APRN

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	363LG0600X	Gerontology Nurse Practitioner	AG03250072	FL
2	363LF0000X	Family Nurse Practitioner	APRN11038957	FL

General Provider Information

NPI Number	:	1982406385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAUSHA CHARAE MCCLAIN APRN

Provider Business Mailing Address
First Line	:	2460 OLD MOULTRIE RD STE 1
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-4198
Country	:	US
Telephone Number	:	904-609-1357
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 CASSAT AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-7084
Country	:	US
Telephone Number	:	904-388-2820
Fax Number	:

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

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	03/02/2026

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