Healthcare Provider Details

I. General information

NPI: 1942777040
Provider Name (Legal Business Name): MEGHAN NOELLE CERJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1864 STADIUM RD
GAINESVILLE FL
32611-1935
US

IV. Provider business mailing address

5307 FISHERSOUND LN
APOLLO BEACH FL
33572-3344
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-0578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: