Provider Demographics
NPI:1346662152
Name:BACHELOR, MEAGAN C (CRNA)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:C
Last Name:BACHELOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4901 GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5151 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8721
Practice Address - Country:US
Practice Address - Phone:850-478-1312
Practice Address - Fax:850-474-9060
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2290599367500000X
FLARNP9305658367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered