MEDICARE: MEGAN PARKER FULLEN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant
3	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1528318235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN PARKER FULLEN

Provider Business Mailing Address
First Line	:	1344 S APOLLO BLVD STE 301
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3185
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1344 S APOLLO BLVD STE 301
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3185
Country	:	US
Telephone Number	:	321-676-2353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	07/11/2013

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Directions to “ MEGAN PARKER FULLEN ” Practice Location

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