Healthcare Provider Details

I. General information

NPI: 1346702800
Provider Name (Legal Business Name): MEAGHAN JUDGE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 SEMINOLE BLVD STE 104
SEMINOLE FL
33772-2522
US

IV. Provider business mailing address

4625 E BAY DR
CLEARWATER FL
33764-5738
US

V. Phone/Fax

Practice location:
  • Phone: 877-301-3441
  • Fax:
Mailing address:
  • Phone: 718-323-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343486
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: