Healthcare Provider Details

I. General information

NPI: 1225709223
Provider Name (Legal Business Name): MEGAN ELIZABETH RACKARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 CREEKSIDE BLVD E UNIT 102
NAPLES FL
34109-0595
US

IV. Provider business mailing address

1303 SE 8TH TER
CAPE CORAL FL
33990-3306
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-8070
  • Fax:
Mailing address:
  • Phone: 239-458-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114986
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: