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General NPI Number Information
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NPI Number | 1609178805
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Entity Type | Individual
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Provider Name | MEGAN L. TETLOW PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 8931 COLONIAL CENTER DR SUITE 400
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City | FORT MYERS
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State | FL
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Zip | 33905-7809
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Country | US
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Telephone | 239-334-6626
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Fax | 239-334-0404
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Provider Business Mailing Address
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Address Line | 2234 COLONIAL BLVD
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City | FORT MYERS
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State | FL
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Zip | 33907-1412
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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