Provider Demographics
NPI:1497217772
Name:BLIESE, MELANIE BETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:BETH
Last Name:BLIESE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3305
Mailing Address - Country:US
Mailing Address - Phone:813-844-1385
Mailing Address - Fax:
Practice Address - Street 1:2501 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3305
Practice Address - Country:US
Practice Address - Phone:813-844-1385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018037873363LF0000X
FLAPRN11001745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily