Provider Demographics
NPI:1144622242
Name:STOCKS, MEAGHAN O'BRIEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:O'BRIEN
Last Name:STOCKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:O'BRIEN
Other - Last Name:NICHOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-2052
Mailing Address - Fax:239-343-5348
Practice Address - Street 1:13681 DOCTORS WAY
Practice Address - Street 2:SUITE 19021
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4300
Practice Address - Country:US
Practice Address - Phone:239-424-1449
Practice Address - Fax:239-424-1421
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015946800Medicaid