Healthcare Provider Details

I. General information

NPI: 1386186492
Provider Name (Legal Business Name): STEPHANIE JO MEGREGIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE MEGREGIAN FOURNIER NP

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR
OCOEE FL
34761-3400
US

IV. Provider business mailing address

10000 W COLONIAL DR
OCOEE FL
34761-3400
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-1378
  • Fax: 321-843-5177
Mailing address:
  • Phone: 321-843-1378
  • Fax: 321-843-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11009642
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024174032
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11009642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: