Provider Demographics
NPI:1952840993
Name:WINK, MEGAN ROTH
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ROTH
Last Name:WINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARY
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5571 N WINSTON PARK BLVD
Mailing Address - Street 2:APT. 102
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-5044
Mailing Address - Country:US
Mailing Address - Phone:561-379-7037
Mailing Address - Fax:
Practice Address - Street 1:5301 SOUTH CONGRESS AVENUE
Practice Address - Street 2:JFK MEDICAL CENTER
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-965-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9265466367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered