Provider Demographics
NPI:1336494244
Name:NINNEMAN, MEGAN (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:NINNEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12493
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33101-2493
Mailing Address - Country:US
Mailing Address - Phone:305-585-5315
Mailing Address - Fax:305-355-2242
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:RESPIRATORY CARE UNIT #324A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-585-5207
Practice Address - Fax:305-585-5380
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2018-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9106198363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant