=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326792821
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN NICHOLLS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2022
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16401 DUNLINDALE DR
-----------------------------------------------------
City | LITHIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33547-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-259-5158
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 501
-----------------------------------------------------
City | LITHIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33547-0501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 13197
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 13197
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------