MEDICARE: MEREDITH CRONENWETT AGPCNP-BC

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	363LG0600X	Gerontology Nurse Practitioner	95009324	CA
2	363LA2200X	Adult Health Nurse Practitioner	95009324	CA
3	363LG0600X	Gerontology Nurse Practitioner	11005561	FL

General Provider Information

NPI Number	:	1427543685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH CRONENWETT AGPCNP-BC

Provider Business Mailing Address
First Line	:	3596 NW DEER OAK DR
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3444
Country	:	US
Telephone Number	:	954-663-9930
Fax Number	:

Provider Business Practice Location Address
First Line	:	3596 NW DEER OAK DR
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3444
Country	:	US
Telephone Number	:	954-663-9930
Fax Number	:

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

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	01/23/2026

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