Provider Demographics
NPI:1881863363
Name:MARBALLIE, MELISSA (FNP)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:
Last Name:MARBALLIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-217-5700
Mailing Address - Fax:954-217-5704
Practice Address - Street 1:2300 N COMMERCE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3255
Practice Address - Country:US
Practice Address - Phone:954-217-5700
Practice Address - Fax:954-217-5704
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335401-1363LF0000X
FL9346165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily