Provider Demographics
NPI:1821230855
Name:STUDEBAKER, MELISSA A (ARNP-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:STUDEBAKER
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:FIEDOR-MAIDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2290 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3133
Mailing Address - Country:US
Mailing Address - Phone:321-254-4776
Mailing Address - Fax:321-254-4840
Practice Address - Street 1:2290 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3133
Practice Address - Country:US
Practice Address - Phone:321-254-4776
Practice Address - Fax:321-254-4840
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2513912363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health