Provider Demographics
NPI:1336450725
Name:DEATON, MELANIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:DEATON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:ELIZABETH
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2144 SAINT CROIX AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-2037
Mailing Address - Country:US
Mailing Address - Phone:239-281-1982
Mailing Address - Fax:
Practice Address - Street 1:2144 SAINT CROIX AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-2037
Practice Address - Country:US
Practice Address - Phone:239-281-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9468806363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000684073OtherANTHEM
IN201002510Medicaid
IN000000891384OtherANTHEM
OH0116838Medicaid
IN000000891384OtherANTHEM