Provider Demographics
NPI:1972656312
Name:TRACHTENBERG, MELISSA LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYNN
Last Name:TRACHTENBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:COOPER-TRACHTENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1800 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3725
Mailing Address - Country:US
Mailing Address - Phone:954-491-2444
Mailing Address - Fax:954-491-8818
Practice Address - Street 1:1800 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3725
Practice Address - Country:US
Practice Address - Phone:954-491-2444
Practice Address - Fax:954-491-8818
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101170363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3713OtherPRESCRIBING PA-C NUMBER