Healthcare Provider Details

I. General information

NPI: 1770256638
Provider Name (Legal Business Name): MISS MEGAN CHRISTINE NUCCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date: 09/17/2025
Reactivation Date: 10/22/2025

III. Provider practice location address

3801 S KANNER HWY
STUART FL
34994-4801
US

IV. Provider business mailing address

2 METRO TRL
HOPATCONG NJ
07843-1523
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-2896
  • Fax:
Mailing address:
  • Phone: 862-432-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9120777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: