Healthcare Provider Details

I. General information

NPI: 1730985185
Provider Name (Legal Business Name): MEGAN LAUREN RAYNOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 W LUMSDEN RD
BRANDON FL
33511-6261
US

IV. Provider business mailing address

1151 PINE RIDGE CIR W APT G2
TARPON SPRINGS FL
34688-6447
US

V. Phone/Fax

Practice location:
  • Phone: 813-925-1903
  • Fax:
Mailing address:
  • Phone: 727-324-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119922
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: