Provider Demographics
NPI:1598376493
Name:CROSKEY, MELISSA (CST/CSFA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CROSKEY
Suffix:
Gender:F
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:N
Other - Last Name:CROSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST/CSFA
Mailing Address - Street 1:7271 BUCKS FORD DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-8379
Mailing Address - Country:US
Mailing Address - Phone:813-924-4332
Mailing Address - Fax:
Practice Address - Street 1:7271 BUCKS FORD DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-8379
Practice Address - Country:US
Practice Address - Phone:813-924-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF01138246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant