Provider Demographics
NPI:1497006944
Name:DAVIDSON, MELISSA ANNE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:BURTON
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:120 INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5031
Mailing Address - Country:US
Mailing Address - Phone:407-333-8166
Mailing Address - Fax:407-333-8928
Practice Address - Street 1:120 INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5031
Practice Address - Country:US
Practice Address - Phone:407-333-8166
Practice Address - Fax:407-333-8928
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2002832163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management