Provider Demographics
NPI:1083066070
Name:HOFFMAN, MELINA DAVITA (NP)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:DAVITA
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4759 LAKEVIEW DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2005
Mailing Address - Country:US
Mailing Address - Phone:863-402-5600
Mailing Address - Fax:863-402-5602
Practice Address - Street 1:4759 LAKEVIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2005
Practice Address - Country:US
Practice Address - Phone:863-402-5600
Practice Address - Fax:863-402-5602
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9300231363LA2200X, 363LG0600X, 363LX0106X
FLRN90300231363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9300231OtherFLORIDA DOH
4917688927OtherNATIONAL REGISTRY
FLQDTZTOtherBCBS FL