Provider Demographics
NPI:1689796518
Name:DEVAUGHN, MELISSA KIM (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KIM
Last Name:DEVAUGHN
Suffix:
Gender:F
Credentials:FNP-BC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1515 E SILVER SPRINGS BLVD
Mailing Address - Street 2:#201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6831
Mailing Address - Country:US
Mailing Address - Phone:352-318-1487
Mailing Address - Fax:352-384-7975
Practice Address - Street 1:1515 E SILVER SPRINGS BLVD
Practice Address - Street 2:#226
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6831
Practice Address - Country:US
Practice Address - Phone:352-547-1596
Practice Address - Fax:352-336-1771
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2020-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP2524142363LP2300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303949800Medicaid