Provider Demographics
NPI:1821385030
Name:BISHOP, MEGHAN WALSH (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:WALSH
Last Name:BISHOP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1102 A1A N
Mailing Address - Street 2:UNIT 104
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4098
Mailing Address - Country:US
Mailing Address - Phone:904-273-6533
Mailing Address - Fax:904-273-6532
Practice Address - Street 1:1633 RACE TRACK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3234
Practice Address - Country:US
Practice Address - Phone:904-287-7000
Practice Address - Fax:904-460-2212
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9219966363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821385030Medicaid
VA1821385030Medicare PIN