Provider Demographics
NPI:1407487820
Name:BIVINS, MELANIE (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:BIVINS
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-4657
Mailing Address - Country:US
Mailing Address - Phone:561-818-4977
Mailing Address - Fax:
Practice Address - Street 1:2500 N MILITARY TRL STE 230
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6318
Practice Address - Country:US
Practice Address - Phone:561-818-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily