Provider Demographics
NPI:1336630045
Name:ARDIZZONE, MEGHAN LUCILLE (APRN)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LUCILLE
Last Name:ARDIZZONE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:LUCILLE
Other - Last Name:HANDLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7539
Mailing Address - Country:US
Mailing Address - Phone:135-284-9008
Mailing Address - Fax:813-355-5064
Practice Address - Street 1:3665 MADACA LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2048
Practice Address - Country:US
Practice Address - Phone:813-280-7380
Practice Address - Fax:813-355-5899
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9330596363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner