Provider Demographics
NPI:1306409032
Name:MCGOVERN, COLLEEN M (APRN)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:M
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:2080 OAKLEY SEAVER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1962
Mailing Address - Country:US
Mailing Address - Phone:321-841-6444
Mailing Address - Fax:407-650-1307
Practice Address - Street 1:2080 OAKLEY SEAVER DR STE 120
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1962
Practice Address - Country:US
Practice Address - Phone:321-841-6444
Practice Address - Fax:407-650-1307
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9367124363LA2200X
FL9367124363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner