MEDICARE: MRS. MEGHAN WALSH BISHOP ARNP

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	363LP0200X	Pediatric Nurse Practitioner	ARNP9219966	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821385030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGHAN WALSH BISHOP ARNP

Provider Business Mailing Address
First Line	:	1102 A1A N
Second Line	:	UNIT 104
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-4098
Country	:	US
Telephone Number	:	904-273-6533
Fax Number	:	904-273-6532

Provider Business Practice Location Address
First Line	:	1633 RACE TRACK RD
Second Line	:	SUITE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-3234
Country	:	US
Telephone Number	:	904-287-7000
Fax Number	:	904-460-2212

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

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	07/30/2012

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