Provider Demographics
NPI:1972932317
Name:KHAISER, MEGHAN JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:JEAN
Last Name:KHAISER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:JEAN
Other - Last Name:SRENIAWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-5864
Mailing Address - Fax:239-343-4760
Practice Address - Street 1:8925 COLONIAL CENTER DR STE 2002
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7813
Practice Address - Country:US
Practice Address - Phone:239-343-5864
Practice Address - Fax:239-343-4760
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004927363A00000X
FLPA9120155363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL126921400Medicaid