Provider Demographics
NPI:1295420925
Name:MELLEN, BRIDGET LEA (CSFA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:LEA
Last Name:MELLEN
Suffix:
Gender:F
Credentials:CSFA
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Mailing Address - Street 1:1420 CELEBRATION BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5162
Mailing Address - Country:US
Mailing Address - Phone:321-442-2454
Mailing Address - Fax:407-386-3006
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:321-442-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant