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NPI Code Detail

MEDICARE: MEGHAN ALYSSA LAROSE PA-C

MEDICARE: MEGHAN ALYSSA LAROSE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA9109489FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16W1ULOTHERFLBC/BS FLORIDA BLUE

General Provider Information

NPI Number : 1205282951
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGHAN ALYSSA LAROSE PA-C
Provider Business Mailing Address
First Line : 38135 MARKET SQ
Second Line :
City : ZEPHYRHILLS
State : FL
Zip : 33542-7505
Country : US
Telephone Number : 813-528-4975
Fax Number :
Provider Business Practice Location Address
First Line : 10004 N DALE MABRY HWY
Second Line : SUITE 101
City : TAMPA
State : FL
Zip : 33618-4494
Country : US
Telephone Number : 813-931-3999
Fax Number : 813-936-7147
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2016
Last Update Date : 06/27/2016

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