Provider Demographics
NPI:1558815498
Name:THOMPSON, MELINDA L
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-2135
Mailing Address - Country:US
Mailing Address - Phone:941-371-4799
Mailing Address - Fax:941-379-0555
Practice Address - Street 1:1500 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2135
Practice Address - Country:US
Practice Address - Phone:941-371-4799
Practice Address - Fax:941-379-0555
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9430026163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management