Healthcare Provider Details

I. General information

NPI: 1740806314
Provider Name (Legal Business Name): JENNY-LYN MEREDITH MCCLAIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S KANNER HWY
STUART FL
34994-7204
US

IV. Provider business mailing address

1320 MALLARD CT
FORT PIERCE FL
34982-3334
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11007598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: