Provider Demographics
NPI:1255131306
Name:JACKSON, MELINDA KAY (ARNP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAY
Last Name:JACKSON
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 OYSTER BAY CIR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-4461
Mailing Address - Country:US
Mailing Address - Phone:727-514-2373
Mailing Address - Fax:
Practice Address - Street 1:7322 LITTLE RD STE 111
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-5589
Practice Address - Country:US
Practice Address - Phone:727-514-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11038240363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care