Provider Demographics
NPI:1407452626
Name:DR. MELISSA RUDD,
Entity Type:Organization
Organization Name:DR. MELISSA RUDD,
Other - Org Name:HEAD2TOE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-405-8436
Mailing Address - Street 1:3522 SADDLE BACK LN
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4765
Mailing Address - Country:US
Mailing Address - Phone:813-541-4962
Mailing Address - Fax:813-405-8436
Practice Address - Street 1:3522 SADDLE BACK LN
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4765
Practice Address - Country:US
Practice Address - Phone:813-541-4962
Practice Address - Fax:813-405-8436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016684300Medicaid