Healthcare Provider Details

I. General information

NPI: 1427257138
Provider Name (Legal Business Name): MEGAN JEAN NAGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4543 WILLAMETTE CIR
ORLANDO FL
32826-4283
US

IV. Provider business mailing address

2438 ORSOTA CIR
OCOEE FL
34761-5002
US

V. Phone/Fax

Practice location:
  • Phone: 407-473-2764
  • Fax:
Mailing address:
  • Phone: 407-654-0026
  • Fax: 407-654-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT21810
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: