Provider Demographics
NPI:1134555022
Name:SMITHDEAL, MELISSA CHRISTINE (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CHRISTINE
Last Name:SMITHDEAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 MARBLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-5580
Mailing Address - Country:US
Mailing Address - Phone:360-713-2440
Mailing Address - Fax:
Practice Address - Street 1:9680 ARGYLE FOREST BLVD STE 18
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-2847
Practice Address - Country:US
Practice Address - Phone:360-713-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60122531390200000X
FLAPRN11031952363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program