Provider Demographics
NPI:1578145033
Name:MELLITI, JENESSIA MARIE (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENESSIA
Middle Name:MARIE
Last Name:MELLITI
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:JENESSIA
Other - Middle Name:MARIE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10932 POSITANO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3900
Mailing Address - Country:US
Mailing Address - Phone:813-389-1267
Mailing Address - Fax:
Practice Address - Street 1:3041 E FLAMINGO RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7447
Practice Address - Country:US
Practice Address - Phone:702-473-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV810968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily