Provider Demographics
NPI:1639884539
Name:MYRIAD HEALTHCARE LLC
Entity Type:Organization
Organization Name:MYRIAD HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:941-202-2305
Mailing Address - Street 1:5460 63RD ST E UNIT B
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-7808
Mailing Address - Country:US
Mailing Address - Phone:217-202-9606
Mailing Address - Fax:941-220-4688
Practice Address - Street 1:5460 63RD ST E UNIT B
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-7808
Practice Address - Country:US
Practice Address - Phone:941-202-2305
Practice Address - Fax:941-220-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care