Healthcare Provider Details

I. General information

NPI: 1265176549
Provider Name (Legal Business Name): MEGAN NICOLE TWIDDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2022
Last Update Date: 04/23/2022
Certification Date: 04/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 SPRING POND PT APT 200
WINTER SPRINGS FL
32708-2871
US

IV. Provider business mailing address

1860 SPRING POND PT APT 200
WINTER SPRINGS FL
32708-2871
US

V. Phone/Fax

Practice location:
  • Phone: 704-807-2283
  • Fax:
Mailing address:
  • Phone: 704-807-2283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: