Healthcare Provider Details

I. General information

NPI: 1083005581
Provider Name (Legal Business Name): MEGHAN LYNN HUMBERT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 BIG BEND RD
RIVERVIEW FL
33578-7419
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-1274
  • Fax: 813-605-6003
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS20197
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: