Provider Demographics
NPI:1922450741
Name:TOWNSEND, MELISSA FAYE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:FAYE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 KASLO CIR NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-8076
Mailing Address - Country:US
Mailing Address - Phone:912-541-2003
Mailing Address - Fax:
Practice Address - Street 1:4450 W EU GALLIE BLVD
Practice Address - Street 2:STE 250
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934
Practice Address - Country:US
Practice Address - Phone:321-751-6671
Practice Address - Fax:904-493-3395
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9366161363LF0000X, 364SH0200X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2016007533OtherANCC CERRTIFICATION