Provider Demographics
NPI:1326783192
Name:JOSEPH, MELISSA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 FAIRWAY ONE DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-8234
Mailing Address - Country:US
Mailing Address - Phone:813-785-8170
Mailing Address - Fax:
Practice Address - Street 1:605 MEDICAL CARE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5942
Practice Address - Country:US
Practice Address - Phone:813-689-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine