Provider Demographics
NPI:1114163144
Name:HOPPE, MELISSA L (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:HOPPE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11724 SEWARD HWY
Mailing Address - Street 2:STE D
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-9708
Mailing Address - Country:US
Mailing Address - Phone:907-224-8733
Mailing Address - Fax:907-224-8734
Practice Address - Street 1:3021 W EAU GALLIE BLVD STE 103
Practice Address - Street 2:SUITE 440
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7005
Practice Address - Country:US
Practice Address - Phone:321-751-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104802363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9104802OtherLICENSE