Provider Demographics
NPI:1255354858
Name:MEREDITH, JASON ANDREW (CTRS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANDREW
Last Name:MEREDITH
Suffix:
Gender:M
Credentials:CTRS
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Other - Credentials:
Mailing Address - Street 1:NORTH FLORIDA/SOUTH GEORGIA MALCOM RANDALL VAMC
Mailing Address - Street 2:1601 S.W. ARCHER ROAD
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1197
Mailing Address - Country:US
Mailing Address - Phone:352-376-1611
Mailing Address - Fax:
Practice Address - Street 1:NORTH FLORIDA/SOUTH GEORGIA MALCOM RANDALL VAMC
Practice Address - Street 2:1601 S.W. ARCHER ROAD
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1197
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR39162225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist