Provider Demographics
NPI:1912374562
Name:MELVIN, MISSY (NURSE ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MISSY
Middle Name:
Last Name:MELVIN
Suffix:
Gender:F
Credentials:NURSE ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 HICKORY LOOP WAY
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-4216
Mailing Address - Country:US
Mailing Address - Phone:352-361-3006
Mailing Address - Fax:
Practice Address - Street 1:72 HICKORY LOOP WAY
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-4216
Practice Address - Country:US
Practice Address - Phone:352-361-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA362478376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide