Provider Demographics
NPI:1003336181
Name:MB PRIMARY CARE LLC
Entity Type:Organization
Organization Name:MB PRIMARY CARE LLC
Other - Org Name:MELISSA BIBB ARNP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:816-258-0431
Mailing Address - Street 1:2213 GLENMOOR RD S
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-4922
Mailing Address - Country:US
Mailing Address - Phone:816-258-0431
Mailing Address - Fax:866-632-1343
Practice Address - Street 1:9555 SEMINOLE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2522
Practice Address - Country:US
Practice Address - Phone:727-394-1500
Practice Address - Fax:866-632-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9400491363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9400491OtherMEDICAL LICENSE
FL01857390Medicaid