Provider Demographics
NPI:1437856606
Name:MORGAN, MELINDA MARTY (PA-C)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MARTY
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 MAGNOLIA HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7357
Mailing Address - Country:US
Mailing Address - Phone:850-830-4175
Mailing Address - Fax:
Practice Address - Street 1:5900 TURKEY LAKE RD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4216
Practice Address - Country:US
Practice Address - Phone:407-351-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant