Provider Demographics
NPI:1629783519
Name:WILMOT, MELINDA KAE (APRN)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAE
Last Name:WILMOT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:KAE
Other - Last Name:BELLAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-0658
Mailing Address - Country:US
Mailing Address - Phone:352-633-7649
Mailing Address - Fax:352-633-7694
Practice Address - Street 1:801 HIGHWAY 466 STE B101
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3925
Practice Address - Country:US
Practice Address - Phone:352-633-7649
Practice Address - Fax:352-633-7649
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily