Provider Demographics
NPI:1346702800
Name:JUDGE, MEAGHAN (NP)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:JUDGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-5738
Mailing Address - Country:US
Mailing Address - Phone:718-323-3773
Mailing Address - Fax:
Practice Address - Street 1:9555 SEMINOLE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2522
Practice Address - Country:US
Practice Address - Phone:877-301-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343486363LF0000X
FLAPRN11007386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1227384OtherLOGISTICS HEALTH INCORPORATED