Provider Demographics
NPI:1508920026
Name:KOLIHA, MELISSA D (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:KOLIHA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:D
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1345 W BAY DR STE 301
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2264
Mailing Address - Country:US
Mailing Address - Phone:727-587-7111
Mailing Address - Fax:
Practice Address - Street 1:1345 W BAY DR STE 301
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2264
Practice Address - Country:US
Practice Address - Phone:727-587-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9103235363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY06T0OtherBLUE CROSS AND BLUE SHIELD
FL292778100Medicaid
FLAB208TMedicare PIN
FLAB208XMedicare PIN
FLAB208YMedicare PIN
FLY06T0OtherBLUE CROSS AND BLUE SHIELD
FLAB208ZMedicare PIN
FL292778100Medicaid