Healthcare Provider Details

I. General information

NPI: 1235521881
Provider Name (Legal Business Name): MEREDITH LEA MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH HESTER LEA

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 DEERWOOD PARK BLVD
JACKSONVILLE FL
32256-0566
US

IV. Provider business mailing address

10151 DEERWOOD PARK BLVD
JACKSONVILLE FL
32256-0566
US

V. Phone/Fax

Practice location:
  • Phone: 855-732-5181
  • Fax:
Mailing address:
  • Phone: 855-732-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number243108
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: