Provider Demographics
NPI:1528534161
Name:MEDLIN, MELISSA J (ARNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W RUSKA PL
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34434-6179
Mailing Address - Country:US
Mailing Address - Phone:352-533-1088
Mailing Address - Fax:
Practice Address - Street 1:4701 SW COLLEGE RD STE 102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4739
Practice Address - Country:US
Practice Address - Phone:352-482-0571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9420312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OtherPHARMACY