Provider Demographics
NPI:1205599396
Name:WARDEN, MEGAN REESE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:REESE
Last Name:WARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15420 PLANTATION OAKS DR APT 13
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2119
Mailing Address - Country:US
Mailing Address - Phone:256-505-9115
Mailing Address - Fax:
Practice Address - Street 1:15420 PLANTATION OAKS DR APT 13
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2119
Practice Address - Country:US
Practice Address - Phone:256-505-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer