Healthcare Provider Details

I. General information

NPI: 1336758101
Provider Name (Legal Business Name): MEGHAN KATHLEEN CICCARELLO DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 BENMORE DR
WINTER PARK FL
32792-4101
US

IV. Provider business mailing address

132 BENMORE DR
WINTER PARK FL
32792-4101
US

V. Phone/Fax

Practice location:
  • Phone: 407-299-7333
  • Fax: 407-644-6070
Mailing address:
  • Phone: 407-299-7333
  • Fax: 407-644-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11015263
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number13-135589-052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: