Provider Demographics
NPI:1851057285
Name:FIZZY, MELANIE (ARNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:FIZZY
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 1:508 W WARNER CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-2937
Mailing Address - Country:US
Mailing Address - Phone:813-727-4248
Mailing Address - Fax:
Practice Address - Street 1:4625 E BAY DR STE 222
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6867
Practice Address - Country:US
Practice Address - Phone:727-288-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014837363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty