Provider Demographics
NPI:1265157119
Name:ARCHIBALD, MELISSA (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 WILBUR ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5324
Mailing Address - Country:US
Mailing Address - Phone:813-655-4646
Mailing Address - Fax:
Practice Address - Street 1:538 WILBUR ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5324
Practice Address - Country:US
Practice Address - Phone:813-655-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily