Provider Demographics
NPI:1306439500
Name:MEYERS, FELICIA
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N MILLS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5735
Mailing Address - Country:US
Mailing Address - Phone:800-484-6801
Mailing Address - Fax:800-484-6801
Practice Address - Street 1:401 N MILLS AVE STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5735
Practice Address - Country:US
Practice Address - Phone:800-484-6801
Practice Address - Fax:800-484-6801
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9244869163W00000X, 163W00000X
IN20043357A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL834242985Medicaid