Healthcare Provider Details

I. General information

NPI: 1831740430
Provider Name (Legal Business Name): MEGAN LOUISE MARTIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN LOUISE CROMER RN

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 W UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

590 DOMMERICH DR
MAITLAND FL
32751-4571
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-8191
  • Fax:
Mailing address:
  • Phone: 423-653-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11004185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: