Provider Demographics
NPI:1497336051
Name:SMITH, MELISSA JENNIFER
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JENNIFER
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JENNIFER
Other - Last Name:BIEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14060 PRATER CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0867
Mailing Address - Country:US
Mailing Address - Phone:307-258-0384
Mailing Address - Fax:
Practice Address - Street 1:14060 PRATER CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0867
Practice Address - Country:US
Practice Address - Phone:307-258-0384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program