Healthcare Provider Details

I. General information

NPI: 1225303274
Provider Name (Legal Business Name): MEGAN ELIZABETH FRERICKS HAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13350 REFLECTIONS PARKWAY SUITE 4-402
FORT MEYERS FL
33907-6539
US

IV. Provider business mailing address

851 BROKEN SOUND PARKWAY NW SUITE 120
BOCA RATON FL
33487-3638
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-1110
  • Fax: 239-437-9589
Mailing address:
  • Phone: 561-367-1623
  • Fax: 561-299-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4855
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: