Provider Demographics
NPI: | 1811009020 |
---|---|
Name: | MEKAS, JEAN G (ARNP) |
Entity type: | Individual |
Prefix: | |
First Name: | JEAN |
Middle Name: | G |
Last Name: | MEKAS |
Suffix: | |
Gender: | F |
Credentials: | ARNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3920 MICHIGAN AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT MYERS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33916-2205 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 239-656-2536 |
Mailing Address - Fax: | 239-656-2555 |
Practice Address - Street 1: | 3920 MICHIGAN AVE |
Practice Address - Street 2: | |
Practice Address - City: | FORT MYERS |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33916-2205 |
Practice Address - Country: | US |
Practice Address - Phone: | 239-656-2536 |
Practice Address - Fax: | 239-656-2555 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-01 |
Last Update Date: | 2012-12-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ARNP2077132 | 363LW0102X, 363LX0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No | 363LX0001X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 033697100 | Medicaid |