Provider Demographics
NPI:1558434225
Name:REIS, MELANIE (ARNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:REIS
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 1:235 E PRINCETON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5553
Mailing Address - Country:US
Mailing Address - Phone:407-303-1444
Mailing Address - Fax:407-303-1446
Practice Address - Street 1:235 E PRINCETON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5553
Practice Address - Country:US
Practice Address - Phone:407-303-1444
Practice Address - Fax:407-303-1446
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP863292363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303574300Medicaid
FLE5384ZMedicare PIN
FL303574300Medicaid
FLE2987ZMedicare PIN