Provider Demographics
NPI:1073866927
Name:ECONOPOULY, MEGAN ASHLEE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ASHLEE
Last Name:ECONOPOULY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PALERMO PL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2821
Mailing Address - Country:US
Mailing Address - Phone:941-484-4778
Mailing Address - Fax:
Practice Address - Street 1:209 PALERMO PL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2821
Practice Address - Country:US
Practice Address - Phone:941-484-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant