Healthcare Provider Details

I. General information

NPI: 1013678887
Provider Name (Legal Business Name): MEGAN ROSE MCGILL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25097 OLYMPIA AVE STE 202
PUNTA GORDA FL
33950-3914
US

IV. Provider business mailing address

18228 N US HIGHWAY 41
LUTZ FL
33549-4400
US

V. Phone/Fax

Practice location:
  • Phone: 813-321-1786
  • Fax: 813-321-1787
Mailing address:
  • Phone: 813-321-1786
  • Fax: 813-321-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9122013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: