=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740549880
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGHAN ORTEGA TUTEN RN 9595959
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2012
-----------------------------------------------------
Last Update Date | 10/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12437 COUNTY ROAD 137
-----------------------------------------------------
City | WELLBORN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32094-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-628-7176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12437 COUNTY ROAD 137
-----------------------------------------------------
City | WELLBORN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32094-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-628-7176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | CNA170437
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | 9595959
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------