Healthcare Provider Details

I. General information

NPI: 1790234219
Provider Name (Legal Business Name): MEGAN MCCLAIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 11/03/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 N WICKHAM RD SUITE 302
MELBOURNE FL
32940-2240
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-9561
  • Fax: 321-434-9231
Mailing address:
  • Phone: 321-434-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN9208137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: