Provider Demographics
NPI:1215378831
Name:DINSMORE, MELANIE E (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:E
Last Name:DINSMORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:E
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-223-2832
Mailing Address - Fax:772-223-5646
Practice Address - Street 1:3801 S KANNER HWY STE 300
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4801
Practice Address - Country:US
Practice Address - Phone:772-223-4999
Practice Address - Fax:772-223-4949
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9445297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDCRGKOtherFLORIDA BLUE
FL020498700Medicaid