Healthcare Provider Details

I. General information

NPI: 1932961018
Provider Name (Legal Business Name): MEAGAN ALEXANDRA PUCHALA HERNANDEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 N PROSPECT AVE
LECANTO FL
34461
US

IV. Provider business mailing address

1990 N PROSPECT AVE
LECANTO FL
34461-9792
US

V. Phone/Fax

Practice location:
  • Phone: 352-527-6888
  • Fax:
Mailing address:
  • Phone: 352-527-6888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11030738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: