Basic Information
Provider Information | |||||||||
NPI: | 1184136525 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRONAUER | ||||||||
FirstName: | MEGAN | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ARNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WALDKOETTER | ||||||||
OtherFirstName: | MEGAN | ||||||||
OtherMiddleName: | LYNN | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | ARNP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 15280 NW 79TH CT STE 200 | ||||||||
Address2: |   | ||||||||
City: | MIAMI LAKES | ||||||||
State: | FL | ||||||||
PostalCode: | 330165873 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3055583724 | ||||||||
FaxNumber: | 7869074485 | ||||||||
Practice Location | |||||||||
Address1: | 3126 N FEDERAL HWY | ||||||||
Address2: |   | ||||||||
City: | LIGHTHOUSE POINT | ||||||||
State: | FL | ||||||||
PostalCode: | 330646738 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9547850900 | ||||||||
FaxNumber: | 9547863497 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/25/2017 | ||||||||
LastUpdateDate: | 09/20/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/20/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 9344261 | FL | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
No ID Information.