Provider Demographics
NPI:1578500989
Name:KELLEY, MELANIE L (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:L
Last Name:KELLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LORRAINE
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-8985
Mailing Address - Fax:352-273-9054
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-6985
Practice Address - Fax:352-273-9054
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2174382363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306114100Medicaid
FL306114100Medicaid
FLU5343ZMedicare PIN