Healthcare Provider Details

I. General information

NPI: 1174901391
Provider Name (Legal Business Name): MEGHAN LEIGH MADER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 SE 1ST AVE SUITE 101
OCALA FL
34471-0408
US

IV. Provider business mailing address

2801 SE 1ST AVE SUITE 101
OCALA FL
34471-0408
US

V. Phone/Fax

Practice location:
  • Phone: 352-690-6300
  • Fax: 352-690-6802
Mailing address:
  • Phone: 352-690-6300
  • Fax: 352-690-6802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9292280
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberARNP9292280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: