Healthcare Provider Details

I. General information

NPI: 1306202064
Provider Name (Legal Business Name): MEGAN ROSE MCCLAVE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E ALTAMONTE DR STE 224
ALTAMONTE SPRINGS FL
32701-4832
US

IV. Provider business mailing address

661 E ALTAMONTE DR STE 224
ALTAMONTE SPRINGS FL
32701-4832
US

V. Phone/Fax

Practice location:
  • Phone: 407-830-9000
  • Fax: 407-830-9040
Mailing address:
  • Phone: 407-830-9000
  • Fax: 407-830-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN240228
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9456068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: