Provider Demographics
NPI:1558724393
Name:MARTZ, MELISSA DEEANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DEEANN
Last Name:MARTZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6013 PAPAYA DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-3771
Mailing Address - Country:US
Mailing Address - Phone:772-626-4229
Mailing Address - Fax:
Practice Address - Street 1:672 SW PRIMA VISTA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1820
Practice Address - Country:US
Practice Address - Phone:772-905-2560
Practice Address - Fax:772-336-4341
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9308476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily