Provider Demographics
NPI:1770045932
Name:CASEY, MELINDA MARIE (DNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MARIE
Last Name:CASEY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6318 WILLOW OAK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4625
Mailing Address - Country:US
Mailing Address - Phone:321-695-6163
Mailing Address - Fax:
Practice Address - Street 1:1617 N FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-2414
Practice Address - Country:US
Practice Address - Phone:717-236-4682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994577-NP363L00000X
FLAPRN11001954363L00000X
WAAP61028192363L00000X
PASP021900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner