Provider Demographics
NPI:1518388610
Name:MELUGIN, BRENNA (APRN- FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:MELUGIN
Suffix:
Gender:F
Credentials:APRN- FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 4TH AVE UNIT D
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4338
Mailing Address - Country:US
Mailing Address - Phone:806-414-9944
Mailing Address - Fax:806-414-9930
Practice Address - Street 1:3404 4TH AVE UNIT D
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-4338
Practice Address - Country:US
Practice Address - Phone:806-414-9944
Practice Address - Fax:806-414-9930
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX718533163W00000X
TXAP124536363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX718533OtherRN, BSN, MSN, FNP