Provider Demographics
NPI:1114297264
Name:FIELDING, MELANIE JANE (RN, LM, RM)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JANE
Last Name:FIELDING
Suffix:
Gender:F
Credentials:RN, LM, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 NICHOLS ROAD
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547
Mailing Address - Country:US
Mailing Address - Phone:407-288-3719
Mailing Address - Fax:813-737-2395
Practice Address - Street 1:2030 NICHOLS ROAD
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547
Practice Address - Country:US
Practice Address - Phone:407-288-3719
Practice Address - Fax:813-737-2395
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9214315163WM0102X
FLTMW6176B00000X
ZZ88J1791E176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn