Healthcare Provider Details

I. General information

NPI: 1548998362
Provider Name (Legal Business Name): MEGAN LYNN GUZZARDI MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12416 66TH ST STE A
LARGO FL
33773-3430
US

IV. Provider business mailing address

12416 66TH ST STE A
LARGO FL
33773-3430
US

V. Phone/Fax

Practice location:
  • Phone: 727-547-4700
  • Fax:
Mailing address:
  • Phone: 412-651-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9116445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: