Provider Demographics
NPI:1881076495
Name:RODGERS, MEGAN (CNP)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N CLYDE MORRIS BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2757
Mailing Address - Country:US
Mailing Address - Phone:386-425-5503
Mailing Address - Fax:
Practice Address - Street 1:311 N CLYDE MORRIS BLVD STE 510
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2757
Practice Address - Country:US
Practice Address - Phone:386-425-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005977363LF0000X
MO2015018037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily