Provider Demographics
NPI:1245824176
Name:RICE, MELISSA MERCEDES (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MERCEDES
Last Name:RICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12651 MCGREGOR BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4488
Mailing Address - Country:US
Mailing Address - Phone:239-343-3223
Mailing Address - Fax:239-340-0424
Practice Address - Street 1:12651 MCGREGOR BLVD STE 301
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4488
Practice Address - Country:US
Practice Address - Phone:239-314-3223
Practice Address - Fax:239-400-4240
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109647700Medicaid