Provider Demographics
NPI:1720588866
Name:MELENDEZ, DEBORAH R (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:R
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2770 CAPITAL MEDICAL BLVD STE 109C
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8417
Mailing Address - Country:US
Mailing Address - Phone:904-329-0447
Mailing Address - Fax:
Practice Address - Street 1:2770 CAPITAL MEDICAL BLVD STE 109C
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8417
Practice Address - Country:US
Practice Address - Phone:850-702-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9384333363LA2200X
FLARNP9384333363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health