Healthcare Provider Details

I. General information

NPI: 1356264709
Provider Name (Legal Business Name): MEGAN RENEE HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 RACE TRACK RD
TAMPA FL
33626-1314
US

IV. Provider business mailing address

8580 29TH WAY N APT 301
PINELLAS PARK FL
33782-6214
US

V. Phone/Fax

Practice location:
  • Phone: 813-467-7190
  • Fax:
Mailing address:
  • Phone: 757-470-8593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: