Provider Demographics
NPI:1497294516
Name:POWELL, MEGAN (ARNP, CRNA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:ARNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13003 SPRINGS MANOR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-8437
Mailing Address - Country:US
Mailing Address - Phone:570-380-0746
Mailing Address - Fax:
Practice Address - Street 1:13003 SPRINGS MANOR DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-8437
Practice Address - Country:US
Practice Address - Phone:570-380-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9309908367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered