Healthcare Provider Details

I. General information

NPI: 1407181936
Provider Name (Legal Business Name): PATRICK MICHAEL MEEHAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 DEL PRADO BLVD S UNIT 2-152
CAPE CORAL FL
33904-5788
US

IV. Provider business mailing address

2710 DEL PRADO BLVD S UNIT 2-152
CAPE CORAL FL
33904-5788
US

V. Phone/Fax

Practice location:
  • Phone: 239-910-8764
  • Fax:
Mailing address:
  • Phone: 239-283-4026
  • Fax: 239-283-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMT300311
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN9162385
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN9162385
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT35994
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: