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General NPI Number Information
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NPI Number | 1811433352
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Entity Type | Individual
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Provider Name | MEGAN MICKLER
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Gender | Female
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 4728 N HABANA AVE STE 101B
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City | TAMPA
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State | FL
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Zip | 33614
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Country | US
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Telephone | 813-775-9997
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Fax | 813-775-9997
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Provider Business Mailing Address
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Address Line | 326 17TH AVE NE
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City | ST PETERSBURG
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State | FL
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Zip | 33704-3503
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Country | US
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Telephone | 813-775-9997
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Fax | 813-775-9997
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9313488
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9313488
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License Number State | FL
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