Provider Demographics
NPI:1003409608
Name:STANILKA, MELISSA ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:STANILKA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:STANILKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:1839 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8900
Mailing Address - Country:US
Mailing Address - Phone:727-953-5852
Mailing Address - Fax:
Practice Address - Street 1:1839 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8900
Practice Address - Country:US
Practice Address - Phone:727-322-1054
Practice Address - Fax:727-821-7213
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007866363LF0000X
FLAPRN11007866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113041800Medicaid