| Doctor Name: | MS. MEGHAN ELIZABETH MUCCIGROSSO |
| NPI Number: | 1104265404 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA9107460 |
| Business Practice Address: | 260 Lookout Pl Suite 103 Maitland, FL - 327514485 |
| Business Phone Number: | 3215945523 |
| Business Fax Number: | 4073332140 |
| Mailing Address: | 260 Lookout Pl, Suite 103 MAITLAND |
| State: | FL |
| Postal Code: | 327514485 |
| Phone Number: | 3215945523 |
| Fax Number: | 4073332140 |
| NPI Enumeration Date: | 06/19/2013 |
| NPI Last Update Date: | 03/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA9107460 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |