MEDICARE: MEGAN STATLER JOHNSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	APRN11039652	FL

General Provider Information

NPI Number	:	1053708925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN STATLER JOHNSON APRN

Provider Business Mailing Address
First Line	:	5580 TREEHAVEN CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4028
Country	:	US
Telephone Number	:	239-770-2190
Fax Number	:

Provider Business Practice Location Address
First Line	:	5580 TREEHAVEN CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4028
Country	:	US
Telephone Number	:	239-770-2190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2015
Last Update Date	:	05/21/2025

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