Provider Demographics
NPI:1376087064
Name:BLEVINS, MEGAN (MSN, PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 KINGSLEY AVE STE 701
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4535
Mailing Address - Country:US
Mailing Address - Phone:904-204-2495
Mailing Address - Fax:
Practice Address - Street 1:1543 KINGSLEY AVE STE 701
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4535
Practice Address - Country:US
Practice Address - Phone:352-462-9484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9324673363LF0000X
FLAPRN9324673364SP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019601900Medicaid
FLP01775869OtherRR MEDICARE
FLP01775869OtherRR MEDICARE