Healthcare Provider Details

I. General information

NPI: 1386278851
Provider Name (Legal Business Name): MEGAN NICOLE PRUNYI APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 LAKE HOWELL RD
MAITLAND FL
32751-5222
US

IV. Provider business mailing address

846 LAKE HOWELL RD
MAITLAND FL
32751-5222
US

V. Phone/Fax

Practice location:
  • Phone: 407-767-2477
  • Fax:
Mailing address:
  • Phone: 77-672-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11006300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: