Provider Demographics
NPI:1437109063
Name:TYLER, MELISSA GRIFFIN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:GRIFFIN
Last Name:TYLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:GAIL
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4047
Mailing Address - Country:US
Mailing Address - Phone:904-376-4083
Mailing Address - Fax:904-391-5075
Practice Address - Street 1:836 PRUDENTIAL DR STE 802
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8335
Practice Address - Country:US
Practice Address - Phone:904-202-8290
Practice Address - Fax:904-202-8171
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9164462363LP0200X
CAARNP 21264363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012959500Medicaid
GA003151292AMedicaid
FLHX171ZMedicare PIN