Basic Information
Provider Information
NPI: 1649798315
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VOSS
FirstName: MEGAN
MiddleName: SUZANNE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
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OtherLastName:  
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Mailing Information
Address1: 4205 BELFORT RD STE 4015
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322163623
CountryCode: US
TelephoneNumber: 9044506014
FaxNumber: 9044506401
Practice Location
Address1: 5045 CARPENTER CREEK DR
Address2:  
City: PENSACOLA
State: FL
PostalCode: 325032521
CountryCode: US
TelephoneNumber: 8504162400
FaxNumber: 8504162467
Other Information
ProviderEnumerationDate: 09/01/2017
LastUpdateDate: 03/17/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LW0102X9377713FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health

No ID Information.


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