Healthcare Provider Details

I. General information

NPI: 1578683009
Provider Name (Legal Business Name): CAROLINE ELIZABETH MEEHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 PICCADILLY CIR
CAPE CORAL FL
33991-3163
US

IV. Provider business mailing address

1926 PICCADILLY CIR
CAPE CORAL FL
33991-3163
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9162489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: