Healthcare Provider Details

I. General information

NPI: 1093481822
Provider Name (Legal Business Name): MEGAN LEANNE KRANTZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COLONNADE DR STE 230
PONTE VEDRA BEACH FL
32081-6237
US

IV. Provider business mailing address

PO BOX 748519
ATLANTA GA
30374-8519
US

V. Phone/Fax

Practice location:
  • Phone: 904-376-3800
  • Fax: 904-390-7511
Mailing address:
  • Phone: 904-376-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007216
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12981
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: