Provider Demographics
NPI:1639600844
Name:FITZGERALD, MELISSA SUZANNE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:SUZANNE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 E. SPRING STREET
Mailing Address - Street 2:SPRING FAMILY MEDICAL GROUP
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815
Mailing Address - Country:US
Mailing Address - Phone:562-421-4791
Mailing Address - Fax:
Practice Address - Street 1:6510 E. SPRING STREET
Practice Address - Street 2:SPRING FAMILY MEDICAL GROUP
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815
Practice Address - Country:US
Practice Address - Phone:562-421-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily