Provider Demographics
NPI:1407044944
Name:BELJIC, MEZAAN (MSN, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MEZAAN
Middle Name:
Last Name:BELJIC
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13641 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3444
Mailing Address - Country:US
Mailing Address - Phone:727-394-8540
Mailing Address - Fax:
Practice Address - Street 1:1301 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3120
Practice Address - Country:US
Practice Address - Phone:727-581-8767
Practice Address - Fax:727-585-0380
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2829702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000438000Medicaid
FLY05Y7OtherBCBS
FLE7751XMedicare PIN
FLY05Y7OtherBCBS
FL000438000Medicaid