Healthcare Provider Details

I. General information

NPI: 1750874301
Provider Name (Legal Business Name): MEGAN ELIZABETH BIBBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6844 INTERNATIONAL CENTER BLVD
FORT MYERS FL
33912-7154
US

IV. Provider business mailing address

9537 ROUNDSTONE CIR
FORT MYERS FL
33967-5142
US

V. Phone/Fax

Practice location:
  • Phone: 407-913-3696
  • Fax:
Mailing address:
  • Phone: 407-913-3696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier024014000
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: