Provider Demographics
NPI:1942824594
Name:HODGES, MELISSA A (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:HODGES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LAKE MIRIAM DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2180
Mailing Address - Country:US
Mailing Address - Phone:863-647-2333
Mailing Address - Fax:
Practice Address - Street 1:202 LAKE MIRIAM DR UNIT 1
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2180
Practice Address - Country:US
Practice Address - Phone:863-647-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8932363LF0000X
FL11006812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily