Healthcare Provider Details

I. General information

NPI: 1891498804
Provider Name (Legal Business Name): MEGAN TENNANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 SE 46TH LN UNIT 1-3
CAPE CORAL FL
33904-8617
US

IV. Provider business mailing address

1849 YANKEE TER
NORTH PORT FL
34286-1701
US

V. Phone/Fax

Practice location:
  • Phone: 239-961-3032
  • Fax:
Mailing address:
  • Phone: 941-276-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-264661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: