1184136525 NPI number — MRS. MEGAN LYNN CRONAUER ARNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184136525 NPI number — MRS. MEGAN LYNN CRONAUER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRONAUER
Provider First Name:
MEGAN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALDKOETTER
Provider Other First Name:
MEGAN
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184136525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15280 NW 79TH CT STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33016-5873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-558-3724
Provider Business Mailing Address Fax Number:
786-907-4485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3126 N FEDERAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIGHTHOUSE POINT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33064-6738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-785-0900
Provider Business Practice Location Address Fax Number:
954-786-3497
Provider Enumeration Date:
10/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  9344261 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 023153000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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