Individual provider Active NPI

Alison Elizabeth McCann

  • Nurse Practitioner
  • St Augustine, FL
National Provider Identifier
1407646920
Registry record updated May 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN11039254 Issued in FL
Practice address
2465 US 1 S
St Augustine, FL 32086-6076
Phone
(904) 239-9996
NPI assigned
May 8, 2025
Last updated
May 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN11039254 FL Primary

Addresses

Primary practice location

2465 US 1 S
St Augustine, FL 32086-6076

Mailing address

2465 US 1 S
St Augustine, FL 32086-6076
Phone (904) 239-9996

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251022000110 FL Practitioner - Nurse Practitioner 8123516184 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

220 Presidents Cup Way
Unit 102
Saint Augustine, FL 32092-3725

8825 Perimeter Park Blvd
Suite 403
Jacksonville, FL 32216-1108

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11039254FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kindred Hospitals East, LLC CurrentSince Sep 1, 2025 Accepting new patients
Black Bag Medical Inc CurrentSince Sep 1, 2025 Accepting new patients

Locations

3840 Belfort Rd
Ste 102
Jacksonville, FL 32216
Phone (904) 371-4051

4320 Deerwood Lake Pkwy
Jacksonville, FL 32216
Phone (904) 620-0599

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1407646920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2465 US 1 S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866076",
            "telephone_number": "904-239-9996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2465 US 1 S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866076",
            "telephone_number": "904-239-9996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCANN",
        "first_name": "ALISON",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-08",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11039254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.