Provider Demographics
NPI:1265742332
Name:DOYLE, MELINDA KIM (ARNP)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:KIM
Last Name:DOYLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:511 MEDICAL PLAZA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7328
Mailing Address - Country:US
Mailing Address - Phone:352-728-6808
Mailing Address - Fax:
Practice Address - Street 1:511 MEDICAL PLAZA DR STE 101
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7328
Practice Address - Country:US
Practice Address - Phone:352-728-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10284363LF0000X
FLARNP3307302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily