Provider Demographics
NPI:1548380496
Name:FENGER, MELISSA (CRNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:FENGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15601 S ROUNDTABLE RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3353
Mailing Address - Country:US
Mailing Address - Phone:954-651-1224
Mailing Address - Fax:
Practice Address - Street 1:1901 SW 172ND AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5592
Practice Address - Country:US
Practice Address - Phone:954-538-5336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167312367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered