Provider Demographics
NPI:1730625146
Name:BATES, MEGAN CATHLEEN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CATHLEEN
Last Name:BATES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1995 E OAKLAND PARK BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1149
Mailing Address - Country:US
Mailing Address - Phone:954-791-6146
Mailing Address - Fax:954-337-2733
Practice Address - Street 1:4601 MILITARY TRL STE 208
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4837
Practice Address - Country:US
Practice Address - Phone:561-795-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9110067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant