Provider Demographics
NPI:1659014363
Name:KIRKLAND, MELINDA LOUISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:LOUISE
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11436 N COUNTY ROAD 125
Mailing Address - Street 2:
Mailing Address - City:GLEN ST MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-3906
Mailing Address - Country:US
Mailing Address - Phone:904-586-6950
Mailing Address - Fax:
Practice Address - Street 1:11740 SW 80TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4822
Practice Address - Country:US
Practice Address - Phone:786-235-8534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9335063163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice