Provider Demographics
NPI:1659675569
Name:CABALLERO, MELANIE JANE (ARNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JANE
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:SUITE 100 ATTN:CREDENTIALING
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:213 NW SAINT JAMES DR
Practice Address - Street 2:STE 3
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1291
Practice Address - Country:US
Practice Address - Phone:772-446-4640
Practice Address - Fax:772-446-4922
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX794433363LF0000X
FLARNP9186595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0E45OtherBLUE CROSS BLUE SHIELD
FL008691400Medicaid
FLEX781YMedicare PIN
FLEX781XMedicare PIN