Provider Demographics
NPI:1568455863
Name:BRASWELL, MELINDA P (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:P
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 TRADEWINDS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1810
Mailing Address - Country:US
Mailing Address - Phone:904-655-8007
Mailing Address - Fax:
Practice Address - Street 1:4203 TRADEWINDS DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1810
Practice Address - Country:US
Practice Address - Phone:904-655-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2891552363L00000X
FLAPRN2891552363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304774100Medicaid
FL304774100Medicaid
FLP48899Medicare UPIN