Provider Demographics
NPI:1003691890
Name:RODRIGUEZ-DALLAND, MELISSA R
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:R
Last Name:RODRIGUEZ-DALLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:R
Other - Last Name:DALLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2044 HEARTLAND CIR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-5125
Mailing Address - Country:US
Mailing Address - Phone:808-634-3243
Mailing Address - Fax:
Practice Address - Street 1:2044 HEARTLAND CIR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-5125
Practice Address - Country:US
Practice Address - Phone:808-634-3243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC230137163W00000X
HIRN64431163W00000X
CA723623163W00000X
FLRN9236254163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse