Healthcare Provider Details

I. General information

NPI: 1760925903
Provider Name (Legal Business Name): MEGAN E ANDERSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2016
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HAMPTON POINT DR
ST AUGUSTINE FL
32092-3063
US

IV. Provider business mailing address

PO BOX 45443
SALT LAKE CITY UT
84145-0443
US

V. Phone/Fax

Practice location:
  • Phone: 904-484-7222
  • Fax: 904-391-7437
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-376-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9310997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: