Provider Demographics
NPI:1467907360
Name:NORBERTO, MELINA (PA)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:NORBERTO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8706 RANCHO CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5831
Mailing Address - Country:US
Mailing Address - Phone:321-246-3472
Mailing Address - Fax:
Practice Address - Street 1:141 WEBB DR STE 300
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3951
Practice Address - Country:US
Practice Address - Phone:863-422-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-20
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003284300Medicaid
FLDO177AMedicare PIN